Provider Demographics
NPI:1912006362
Name:KELLER ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:KELLER ARMY COMMUNITY HOSPITAL
Other - Org Name:HAMILTON PHCY
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:BLDG 114 RM 175
Mailing Address - Street 2:
Mailing Address - City:FT HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:11252
Mailing Address - Country:US
Mailing Address - Phone:718-630-4268
Mailing Address - Fax:718-630-4337
Practice Address - Street 1:BLDG 114 RM 175
Practice Address - Street 2:
Practice Address - City:FT HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:11252
Practice Address - Country:US
Practice Address - Phone:718-630-4268
Practice Address - Fax:718-630-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2059046OtherPK
3308120OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1528161916OtherPARENT BILLING NPI