Provider Demographics
NPI:1831418904
Name:US ARMY MEDICAL DEPARTMENT ACTIVITY KOREA UNIT 15244 APO AP 96205-5244
Entity type:Organization
Organization Name:US ARMY MEDICAL DEPARTMENT ACTIVITY KOREA UNIT 15244 APO AP 96205-5244
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KETTELY
Authorized Official - Middle Name:
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:031-730-4558
Mailing Address - Street 1:HHD USAG CP CASEY
Mailing Address - Street 2:UNIT# 15543
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224-5543
Mailing Address - Country:US
Mailing Address - Phone:706-691-7295
Mailing Address - Fax:
Practice Address - Street 1:HHD USAG CP CASEY
Practice Address - Street 2:UNIT# 15543
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96224-5543
Practice Address - Country:US
Practice Address - Phone:706-691-7295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004607286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMSW004607OtherMASTER LEVEL SOCIAL WORKER