Provider Demographics
NPI:1902872039
Name:US ARMY MEDCOM
Entity Type:Organization
Organization Name:US ARMY MEDCOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:703-693-5601
Mailing Address - Street 1:6225 25TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4125
Mailing Address - Country:US
Mailing Address - Phone:727-347-1953
Mailing Address - Fax:
Practice Address - Street 1:900 ARMY NAVY DR
Practice Address - Street 2:SUITE 1533
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-4927
Practice Address - Country:US
Practice Address - Phone:703-418-3716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2261363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty