Provider Demographics
NPI:1710391156
Name:RAYMOND W BLISS ARMY HEALTH CENTER
Entity Type:Organization
Organization Name:RAYMOND W BLISS ARMY HEALTH CENTER
Other - Org Name:DOD FT HUACHUCA EPHCY
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:RAYMOND W. BLISS ARMY HEALTH CENTER
Mailing Address - Street 2:CO MCXJ-RMD-MSAD 2240 E WINROW AVE
Mailing Address - City:FT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-5080
Mailing Address - Country:US
Mailing Address - Phone:520-533-2520
Mailing Address - Fax:520-533-0464
Practice Address - Street 1:2240 WINROW RD BLDG 45001
Practice Address - Street 2:RAYMOND W. BLISS ARMY HEALTH CENTER
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-5080
Practice Address - Country:US
Practice Address - Phone:520-533-2520
Practice Address - Fax:520-533-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146184OtherPK