Provider Demographics
NPI:1568561983
Name:IRELAND ARMY COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:IRELAND ARMY COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:410 MITCHELL
Mailing Address - Street 2:
Mailing Address - City:SELFRIDGE AIR BASE
Mailing Address - State:MI
Mailing Address - Zip Code:48045
Mailing Address - Country:US
Mailing Address - Phone:586-307-5527
Mailing Address - Fax:586-782-0553
Practice Address - Street 1:410 MITCHELL
Practice Address - Street 2:
Practice Address - City:SELFRIDGE AIR BASE
Practice Address - State:MI
Practice Address - Zip Code:48045
Practice Address - Country:US
Practice Address - Phone:586-307-5527
Practice Address - Fax:586-782-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2044519OtherPK