Provider Demographics
NPI:1902103880
Name:US ARMY HEALTH CLINIC BAUMHOLDER
Entity Type:Organization
Organization Name:US ARMY HEALTH CLINIC BAUMHOLDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR OF CLINICAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-485-8813
Mailing Address - Street 1:USAHC-BAUMHOLDER
Mailing Address - Street 2:UNIT 23809 BOX 52
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034-0077
Mailing Address - Country:US
Mailing Address - Phone:067-836-6563
Mailing Address - Fax:
Practice Address - Street 1:USAHC-BAUMHOLDER
Practice Address - Street 2:UNIT 23809 BOX 52
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09034-0077
Practice Address - Country:US
Practice Address - Phone:067-836-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3677286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital