Provider Demographics
NPI:1689773707
Name:US ARMY HEALTH CLINIC
Entity Type:Organization
Organization Name:US ARMY HEALTH CLINIC
Other - Org Name:DUGWAY HC PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR PHRMCY OPERATIONS CNTR
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:210-221-8443
Mailing Address - Street 1:5116 KISTER AVENUE
Mailing Address - Street 2:ATTN MSA OFFICE
Mailing Address - City:DUGWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5116 KISTER AVENUE
Practice Address - Street 2:ROOM #119
Practice Address - City:DUGWAY
Practice Address - State:UT
Practice Address - Zip Code:84022
Practice Address - Country:US
Practice Address - Phone:801-831-2942
Practice Address - Fax:801-831-2552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVANS ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497795702OtherPARENT FACILITY NPI
005252OtherNCPDP PAYMENT CENTER
1497702591OtherFACILITY NPI
4609307OtherOTHER ID NUMBER-COMMERCIAL NUMBER