Provider Demographics
NPI:1720291453
Name:MADIGAN ARMY MEDICAL CTR
Entity Type:Organization
Organization Name:MADIGAN ARMY MEDICAL CTR
Other - Org Name:UMATILLA ARMY DEPOT OHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TPC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-968-6598
Mailing Address - Street 1:9040A JACKSON AVE
Mailing Address - Street 2:ATTN: MCHJ-CSA-U
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-6598
Mailing Address - Fax:
Practice Address - Street 1:78798 ORDNANCE RD
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-9108
Practice Address - Country:US
Practice Address - Phone:541-564-5215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADIGAN ARMY MEDICAL CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-08
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841390077OtherPARENT FACILITY NPI
VAD000Medicare UPIN
OTH000Medicare UPIN