Provider Demographics
NPI:1619337995
Name:RAYMOND W BLISS ARMY HEALTH CENTER
Entity Type:Organization
Organization Name:RAYMOND W BLISS ARMY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICEA
Authorized Official - Middle Name:VICTORIA MAAS
Authorized Official - Last Name:BARROWS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-266-3939
Mailing Address - Street 1:2240 WINROW AVE
Mailing Address - Street 2:
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7079
Mailing Address - Country:US
Mailing Address - Phone:520-266-3939
Mailing Address - Fax:
Practice Address - Street 1:2240 WINROW AVE
Practice Address - Street 2:
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7079
Practice Address - Country:US
Practice Address - Phone:520-266-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN146926261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center