Provider Demographics
NPI:1740421460
Name:MADIGAN ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:MADIGAN ARMY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF DEPT OF PSYCHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHERAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-968-2751
Mailing Address - Street 1:MAMC DEPT OF PSYCHOLOGY
Mailing Address - Street 2:BLDG 9040 FITZSIMMONS DRIVE
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-2700
Mailing Address - Fax:253-968-3731
Practice Address - Street 1:MAMC DEPT OF PSYCHOLOGY
Practice Address - Street 2:BLDG 9040 FITZSIMMONS DRIVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-2700
Practice Address - Fax:253-968-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2245286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital