Provider Demographics
NPI:1538393327
Name:UNITED STATES COAST GUARD
Entity type:Organization
Organization Name:UNITED STATES COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-437-3582
Mailing Address - Street 1:COAST GUARD ISLAND
Mailing Address - Street 2:ISC ALAMEDA CLINIC BLDG. 1
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-437-3582
Mailing Address - Fax:
Practice Address - Street 1:ISC ALAMEDA
Practice Address - Street 2:COAST GUARD ISLAND, BLDG 1
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-437-3582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient