Provider Demographics
NPI:1699269852
Name:WILFORD HALL MEDICAL CENTER
Entity type:Organization
Organization Name:WILFORD HALL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MTF SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:1940 CARSWELL AVE
Mailing Address - Street 2:BLDG 7002
Mailing Address - City:LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-671-9637
Mailing Address - Fax:210-671-6486
Practice Address - Street 1:1940 CARSWELL AVE
Practice Address - Street 2:BLDG 7002
Practice Address - City:LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-671-9637
Practice Address - Fax:210-671-6486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILFORD HALL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy