Provider Demographics
NPI:1992107627
Name:MUNSON ARMY HEALTH CENTER
Entity type:Organization
Organization Name:MUNSON ARMY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF, PHARMACY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:APARNA
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:RAIZADA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:913-684-6054
Mailing Address - Street 1:550 POPE AVE
Mailing Address - Street 2:BLDG 343, ROOM 1A146
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-2332
Mailing Address - Country:US
Mailing Address - Phone:913-684-6054
Mailing Address - Fax:
Practice Address - Street 1:550 POPE AVE
Practice Address - Street 2:BLDG 343, ROOM 1A146
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXW2P4AAOtherUS ARMY MEDICAL COMMAND UIC