Provider Demographics
NPI:1649682154
Name:UNITED STATES NAVY
Entity type:Organization
Organization Name:UNITED STATES NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOFFSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:IDC
Authorized Official - Phone:619-537-3274
Mailing Address - Street 1:LOGISTICS SUPPORT UNIT ONEMEDIC
Mailing Address - Street 2:2424 REDOVA RD BLDG 156
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5401
Mailing Address - Country:US
Mailing Address - Phone:619-537-3274
Mailing Address - Fax:
Practice Address - Street 1:LOGISTICS SUPPORT UNIT ONEMEDIC
Practice Address - Street 2:2424 REDOVA RD BLDG 156
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5401
Practice Address - Country:US
Practice Address - Phone:619-537-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)