Provider Demographics
NPI:1023247806
Name:325TH COMBAT SUPPORT HOSPITAL
Entity type:Organization
Organization Name:325TH COMBAT SUPPORT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:913-588-1551
Mailing Address - Street 1:11101 E INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64054-1511
Mailing Address - Country:US
Mailing Address - Phone:816-836-0005
Mailing Address - Fax:
Practice Address - Street 1:11101 E INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64054-1511
Practice Address - Country:US
Practice Address - Phone:816-836-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY534297-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility