Provider Demographics
NPI:1215122817
Name:UNITED STATES NAVY
Entity type:Organization
Organization Name:UNITED STATES NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:IDC
Authorized Official - Phone:910-451-4042
Mailing Address - Street 1:PSC BOX 20095
Mailing Address - Street 2:COMMANDING OFFICER 2ND BATTALION, 2ND MARINES
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0095
Mailing Address - Country:US
Mailing Address - Phone:910-451-4042
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER
Practice Address - Street 2:2ND BATTALION 2ND MARINES
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:28542-0095
Practice Address - Country:US
Practice Address - Phone:910-451-4042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710I002XOtherINDEPENDENT DUTY CORPSMAN