Provider Demographics
NPI:1629066642
Name:18THMEDCOM
Entity Type:Organization
Organization Name:18THMEDCOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SOONHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:011-822-7917
Mailing Address - Street 1:121GENERAL HOSPITAL
Mailing Address - Street 2:BOX709
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:US
Mailing Address - Phone:0118227-916-6027
Mailing Address - Fax:
Practice Address - Street 1:121GENERAL HOSPITAL
Practice Address - Street 2:BOX709
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:US
Practice Address - Phone:0118227-916-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0165412865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital