Provider Demographics
NPI:1699877993
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:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-361-5948
Mailing Address - Street 1:1060 GAFFNEY RD #7420
Mailing Address - Street 2:ATTN MCUC-PAD-TPC
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7420
Mailing Address - Country:US
Mailing Address - Phone:907-361-5948
Mailing Address - Fax:907-361-4832
Practice Address - Street 1:1060 GAFFNEY RD # 7420
Practice Address - Street 2:
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7420
Practice Address - Country:US
Practice Address - Phone:907-361-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No341800000XTransportation ServicesMilitary/U.S. Coast Guard Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0202351OtherPHARMACY NCPDP
AN2598588OtherMEDCO
AN2598588OtherMEDCO
VAD000Medicare UPIN