Provider Demographics
NPI:1598864621
Name:WALTER REED NATIONAL MILITARY MED CENTER
Entity Type:Organization
Organization Name:WALTER REED NATIONAL MILITARY MED CENTER
Other - Org Name:QUANTICO MAIN PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:QUANTICO NMC ATTN: THIRD PARTY BILLING
Mailing Address - Street 2:3259 CATLIN AVE
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134
Mailing Address - Country:US
Mailing Address - Phone:703-784-1579
Mailing Address - Fax:703-784-1592
Practice Address - Street 1:NMC 2200 LESTER AVENUE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134
Practice Address - Country:US
Practice Address - Phone:703-784-1579
Practice Address - Fax:703-784-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105196OtherPK