Provider Demographics
NPI:1689782021
Name:USAMEDDAC WUERZBERG,UNIT 26610
Entity Type:Organization
Organization Name:USAMEDDAC WUERZBERG,UNIT 26610
Other - Org Name:ATTN; CREDENTIALS OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:AMERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:0964-183-7426
Mailing Address - Street 1:CMR415
Mailing Address - Street 2:BOX 5021
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114
Mailing Address - Country:DE
Mailing Address - Phone:01149964-183-7426
Mailing Address - Fax:
Practice Address - Street 1:GRAFENWOHER HEALTH CLINIC
Practice Address - Street 2:CMR 415; BOX 5021
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09114
Practice Address - Country:DE
Practice Address - Phone:01149964-183-7426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28158207A313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN