Provider Demographics
NPI:1205898871
Name:MADIGAN ARMY MEDICAL CENTER
Entity type:Organization
Organization Name:MADIGAN ARMY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-968-2252
Mailing Address - Street 1:9040 REID ST.
Mailing Address - Street 2:ATTN. MCHJ-QCR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-3278
Mailing Address - Country:US
Mailing Address - Phone:253-986-2252
Mailing Address - Fax:253-986-3278
Practice Address - Street 1:437 CABRILLO ST
Practice Address - Street 2:SUITE AIA -US ARMY HEALTH CLINIC
Practice Address - City:PRESIDO OF MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944
Practice Address - Country:US
Practice Address - Phone:831-242-7589
Practice Address - Fax:831-242-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD057431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04753OtherLISCENSE