Provider Demographics
NPI:1598083461
Name:DEPARTMENT OF THE ARMY
Entity Type:Organization
Organization Name:DEPARTMENT OF THE ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO-ANN
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:TAALIB
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW, MAC
Authorized Official - Phone:031-730-4488
Mailing Address - Street 1:US ARMY MEDICAL DEPARTMENT ACTIVITY-KOREA
Mailing Address - Street 2:UNIT 15244
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5244
Mailing Address - Country:US
Mailing Address - Phone:031-730-4488
Mailing Address - Fax:
Practice Address - Street 1:US ARMY MEDICAL DEPARTMENT ACTIVITY-KOREA
Practice Address - Street 2:UNIT 15244
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5244
Practice Address - Country:US
Practice Address - Phone:031-730-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26834OtherSUBSTANCE ABUSE