Provider Demographics
NPI:1285731034
Name:NAVAL HOSPITAL JACKSONVILLE
Entity type:Organization
Organization Name:NAVAL HOSPITAL JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA POSC
Authorized Official - Prefix:MR
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 1:2080 CHILD ST # 0601
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:229-639-5976
Mailing Address - Fax:229-639-7881
Practice Address - Street 1:814 RADFORD BLVD
Practice Address - Street 2:BLDG 7200
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31704-5000
Practice Address - Country:US
Practice Address - Phone:229-639-5976
Practice Address - Fax:229-639-7881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL JACKSONVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020386OtherPK