Provider Demographics
NPI:1881952661
Name:UNDERWATER CONSTRUCTION TEAM TWO
Entity type:Organization
Organization Name:UNDERWATER CONSTRUCTION TEAM TWO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CORPSMAN IDC
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:DIVE IDC
Authorized Official - Phone:805-982-6682
Mailing Address - Street 1:4643 DOCK ROAD BLDG 524
Mailing Address - Street 2:UNDERWATER CONSTRUCTION TEAM TWO
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93043
Mailing Address - Country:US
Mailing Address - Phone:805-982-6682
Mailing Address - Fax:805-982-3246
Practice Address - Street 1:4643 DOCK ROAD BLDG 524
Practice Address - Street 2:UNDERWATER CONSTRUCTION TEAM TWO
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043
Practice Address - Country:US
Practice Address - Phone:805-982-6682
Practice Address - Fax:805-982-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3418M1110XTransportation ServicesMilitary/U.S. Coast Guard TransportMilitary or U.S. Coast Guard Ambulance, Ground Transport