Provider Demographics
NPI:1760416614
Name:WILFORD HALL MEDICAL CENTER
Entity Type:Organization
Organization Name:WILFORD HALL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CYSTIC FIBROSIS/ASTHMA COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:CHAPA-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PED NURSE PRACTITION
Authorized Official - Phone:210-292-7170
Mailing Address - Street 1:2200 BERGQUIST DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LACKLAND A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:210-292-7170
Mailing Address - Fax:210-292-7209
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-7170
Practice Address - Fax:210-292-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX529878286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital