Provider Demographics
NPI:1730178229
Name:18TH MEDCOM, DCSFHP-OHS
Entity type:Organization
Organization Name:18TH MEDCOM, DCSFHP-OHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL HEALTH NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:MISO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-736-6692
Mailing Address - Street 1:121ST GENERAL HOSPITAL. BOX#567
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:KR
Mailing Address - Phone:315-736-6692
Mailing Address - Fax:315-736-3028
Practice Address - Street 1:121ST GENERAL HOSPITAL. BOX#567
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:KR
Practice Address - Phone:315-736-6692
Practice Address - Fax:315-736-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital