Provider Demographics
NPI:1629474085
Name:WACH
Entity Type:Organization
Organization Name:WACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-332-4787
Mailing Address - Street 1:200 CARLIE CT
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3810
Mailing Address - Country:US
Mailing Address - Phone:912-332-4787
Mailing Address - Fax:
Practice Address - Street 1:200 CARLIE CT
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3810
Practice Address - Country:US
Practice Address - Phone:912-332-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital