Provider Demographics
NPI:1720492093
Name:NAVAL HEALTH CLINIC QUANTICO
Entity Type:Organization
Organization Name:NAVAL HEALTH CLINIC QUANTICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUMED UBO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:THE TREASURER OF THE UNITED STATES
Mailing Address - Street 2:3259 CATLIN AVE
Mailing Address - City:QUANTICO
Mailing Address - State:DC
Mailing Address - Zip Code:20374
Mailing Address - Country:US
Mailing Address - Phone:202-433-6808
Mailing Address - Fax:928-269-0890
Practice Address - Street 1:BRANCH HEALTH CLINIC WNY
Practice Address - Street 2:915 N STREET S.E BLDG 175
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5022
Practice Address - Country:US
Practice Address - Phone:202-433-6808
Practice Address - Fax:202-685-1372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC QUANTICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-16
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146316OtherPK