Provider Demographics
NPI:1558566935
Name:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C, PAD
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-798-8491
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:ATTN UBO
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-8286
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:USADC
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-18
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient