Provider Demographics
NPI:1760723894
Name:MEDDAC J
Entity Type:Organization
Organization Name:MEDDAC J
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-263-4610
Mailing Address - Street 1:USAG-J UNIT 45013 BOX 3304
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338-5011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 704 BOX 3304
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338-0014
Practice Address - Country:US
Practice Address - Phone:315-263-4610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital