Provider Demographics
NPI:1295724409
Name:18TH MEDCOM
Entity type:Organization
Organization Name:18TH MEDCOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL HEALTH NURSING SUPERVI
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAN
Authorized Official - Middle Name:YI
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, COHN
Authorized Official - Phone:315-736-7565
Mailing Address - Street 1:121ST GENERAL HOSPITAL BOX 539
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-0017
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDCOM UNIT # 15281
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-0054
Practice Address - Country:KR
Practice Address - Phone:315-736-3025
Practice Address - Fax:315-736-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524305261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine