Provider Demographics
NPI:1649379363
Name:WALTER REED NATIONAL MILITARY MED CENTER
Entity Type:Organization
Organization Name:WALTER REED NATIONAL MILITARY MED CENTER
Other - Org Name:WALTER REED SOLDIERS HOME 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 1:9300 DEWITT LOOP
Mailing Address - Street 2:C/O FBCH OTPT TPCP
Mailing Address - City:FT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:703-805-9064
Mailing Address - Fax:
Practice Address - Street 1:BLDG 2 RM 7817
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-782-4737
Practice Address - Fax:202-782-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004801OtherPK
0904094OtherOTHER ID NUMBER-COMMERCIAL NUMBER