Provider Demographics
NPI:1053410100
Name:BASSETT ARMY COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:BASSETT 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:BASSETT ARMY COMMUNITY HOSPITAL ATTN MCUC-PAD-TPC 1060
Mailing Address - Street 2:
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7420
Mailing Address - Country:US
Mailing Address - Phone:210-221-8274
Mailing Address - Fax:210-295-2567
Practice Address - Street 1:1060 GAFFNEY RD STOP 7400
Practice Address - Street 2:BUILDING 3406
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5007
Practice Address - Country:US
Practice Address - Phone:907-353-4128
Practice Address - Fax:907-353-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1996971OtherPK
005278OtherNCPDP PAYMENT CENTER
1699877993OtherPARENT NPI