Provider Demographics
NPI:1609269307
Name:DEPARTMENT OF DEFENCE
Entity Type:Organization
Organization Name:DEPARTMENT OF DEFENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY COMMANDER FOR NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARIDO
Authorized Official - Suffix:
Authorized Official - Credentials:COL
Authorized Official - Phone:803-751-2119
Mailing Address - Street 1:2000 N BELTLINE BLVD APT 313
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-3942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4500 STUART ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-751-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337835-1286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital