Provider Demographics
NPI:1306049895
Name:RAYMOND W. BLISS ARMY HEALTH CENTER
Entity type:Organization
Organization Name:RAYMOND W. BLISS ARMY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-533-9685
Mailing Address - Street 1:2240 E WINROW AVE
Mailing Address - Street 2:ATTN MCXJ-RMD-MSAO
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7079
Mailing Address - Country:US
Mailing Address - Phone:520-533-9685
Mailing Address - Fax:
Practice Address - Street 1:45005 ARIZONA STREET
Practice Address - Street 2:
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:520-533-1479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAYMOND W. BLISS ARMY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-11
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient