BLANCHFIELD ARMY COMMUNITY HOSPITAL (EBH3-FT. CAMPBELL) - NPI NUMBER 1154757219

Summary

Provider Name: BLANCHFIELD ARMY COMMUNITY HOSPITAL (EBH3-FT. CAMPBELL)

NPI Number: 1154757219

Clasification: Clinic/Center (261QM1100X)

Specialization: Military/U.S. Coast Guard Outpatient

Address:
30TH STREET AND DESERT STORM AVENUE
BLDG 6988
FORT CAMPBELL, KY
ZIP 42223

Phone Number: (270) 798-8400



Detailed Information

BLANCHFIELD ARMY COMMUNITY HOSPITAL is a military/u.s. coast guard outpatient clinic/center in Fort Campbell, KY. The provider is the Defense Health Program or U.S. Coast Guard funded �fixed� facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A �fixed� facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the �fixed� facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. The assigned NPI number for this provider is 1154757219 and is registered as an organization entity type.
The provider Is Doing Business As Ebh3-ft. Campbell.

The provider's business address is:

30TH STREET AND DESERT STORM AVENUE
BLDG 6988
FORT CAMPBELL, KY
ZIP 42223-318
Phone: (270) 798-8400

The provider's authorized official is Liza J O'neal .
The authorized official title is C, Pad and has the following contact phone number (270) 798-8491.

The enumeration date for this NPI number is 9/20/2013 and was last updated on 9/20/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM1100X Clinic/Center Military/U.S. Coast Guard Outpatient Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 VAD000 MEDICARE UPIN

NPI Record

No. Field Name Field Value
1 NPI 1154757219
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name BLANCHFIELD ARMY COMMUNITY HOSPITAL
5 Provider Other Organization Name EBH3-FT. CAMPBELL
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 30TH STREET AND DESERT STORM AVENUE
8 Provider Second Line Business Practice Location Address BLDG 6988
9 Provider Business Practice Location Address City Name FORT CAMPBELL
10 Provider Business Practice Location Address State Name KY
11 Provider Business Practice Location Address Postal Code 422235318
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 2707988400
14 Provider Enumeration Date 9/20/2013
15 Last Update Date 9/20/2013
16 Authorized Official Last Name O'NEAL
17 Authorized Official First Name LIZA
18 Authorized Official Middle Name J
19 Authorized Official Title or Position C, PAD
20 Authorized Official Telephone Number 2707988491
21 Healthcare Provider Taxonomy Code 1 261QM1100X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 VAD000
24 Other Provider Identifier Type Code 1 02
25 Is Organization Subpart Y
26 Parent Organization LBN BLANCHFIELD ARMY COMMUNITY HOSPITAL
27 Parent Organization TIN

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This page was last updated on: 7/15/2014
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