Provider Demographics
NPI:1821202151
Name:MCDONALD ARMY HEALTH CENTER
Entity Type:Organization
Organization Name:MCDONALD ARMY HEALTH CENTER
Other - Org Name:AHC MONROE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO REP
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-314-7755
Mailing Address - Street 1:579 JEFFERSON AVE
Mailing Address - Street 2:ATTN UBO
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-1526
Mailing Address - Country:US
Mailing Address - Phone:757-314-7770
Mailing Address - Fax:
Practice Address - Street 1:60 INGALLS RD
Practice Address - Street 2:
Practice Address - City:FORT MONROE
Practice Address - State:VA
Practice Address - Zip Code:23651-1032
Practice Address - Country:US
Practice Address - Phone:757-314-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDONALD ARMY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922199066OtherPARENT FACILITY NPI
1922199066OtherPARENT FACILITY NPI
VAD000Medicare UPIN