Provider Demographics
NPI:1336589993
Name:USAMEDDAC-JAPAN
Entity Type:Organization
Organization Name:USAMEDDAC-JAPAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-263-4606
Mailing Address - Street 1:BG SAMS AHC, USAMEDDAC-JAPAN
Mailing Address - Street 2:MCJA-PM, UNIT 45011
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96343-5011
Mailing Address - Country:US
Mailing Address - Phone:315-263-5050
Mailing Address - Fax:315-263-4100
Practice Address - Street 1:BG SAMS AHC, USAMEDDAC-JAPAN
Practice Address - Street 2:MCJA-PM, UNIT 45011
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96343-5011
Practice Address - Country:US
Practice Address - Phone:315-263-5050
Practice Address - Fax:315-263-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001227332261QM1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1103XAmbulatory Health Care FacilitiesClinic/CenterMilitary Ambulatory Procedure Visits Operational (Transportable)