BLANCHFIELD ARMY COMMUNITY HOSPITAL (NPI# 1275846263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275846263 |
| Entity Type | Organization |
| Organization Name | BLANCHFIELD ARMY COMMUNITY HOSPITAL |
| Other Organization Name | SCREAMING EAGLE MEDICAL HOME-CAMPB |
| Practice Address |
647 Dunlop Ln Gateway Medical Center Medical Office Bldg One Clarksville TN 37040-5165 |
| Mailing Address |
650 Joel Dr Attn Ubo Fort Campbell KY 42223-5318 |
| Practice Telephone | 2704615019 |
| Mailing Telephone | 2707988286 |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2013-01-03 |
| Authorized Official Name | LIZA J O'NEAL (C, PAD) |
| Authorized Official Telephone | 2707988491 |
| Is Organization Subpart | Y |
| Parent Organization Name | BLANCHFIELD ARMY COMMUNITY HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PARENT BILLING NPI | 1417044702 | 01 |
| Other Name | Type Code |
|---|---|
| SCREAMING EAGLE MEDICAL HOME-CAMPB | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942783246 | Blanchfield Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 110 Pharm Usa Health Clinic, Rock Island, IL 61299-0001 | 2018-09-12 |
| 1396145306 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 2403, Air Assault St and Indiana Ave, Fort Campbell, KY 42223 | 2014-08-27 |
| 1659785053 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 6747 A Shau Valley Road, Fort Campbell, KY 42223 | 2014-06-13 |
| 1215340401 | Blanchfield Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 98a Michigan Ave, Fort Campbell, KY 42223-5622 | 2014-06-05 |
| 1336575497 | Blanchfield Army Community Hospital | Clinic/Center | Toccoa Road Bldg 70344, Fort Campbell, KY 42223-5318 | 2013-09-20 |
| 1518393677 | Blanchfield Army Community Hospital | Clinic/Center | 53rd Street and Indiana Ave, Bldg 3929, Fort Campbell, KY 42223-5318 | 2013-09-20 |
| 1427484583 | Blanchfield Army Community Hospital | Clinic/Center | 55th Street and Indiana Avenue, Bldg 3960, Fort Campbell, KY 42223-5318 | 2013-09-20 |
| 1154757219 | Blanchfield Army Community Hospital | Clinic/Center | 30th Street and Desert Storm Avenue, Bldg 6988, Fort Campbell, KY 42223-5318 | 2013-09-20 |
| 1376982413 | Blanchfield Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 650 Joel Dr Bldg B, Fort Campbell, KY 42223-5318 | 2013-06-21 |
| 1457643231 | Blanchfield Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 7973 Strike Blvd, Fort Campbell, KY 42223 | 2011-05-11 |
| Street Address |
647 DUNLOP LN GATEWAY MEDICAL CENTER MEDICAL OFFICE BLDG ONE |
| City | CLARKSVILLE |
| State | TN |
| Zip Code | 37040-5165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942291372 | Theodore F Ritzer | Internal Medicine | 647 Dunlop Ln, Ste 101, Clarksville, TN 37040-5165 | 2005-11-03 |
| 1780199554 | Barbara Oland | Nurse Practitioner | 647 Dunlop Ln, Clarksville, TN 37040-5165 | 2017-12-02 |
| 1407083306 | Pain Management of Middle Tennessee Pllc | Pain Medicine | 647 Dunlop Ln, Ste 305 Pmb 31, Clarksville, TN 37040-5165 | 2009-06-17 |
| 1932335551 | Gateway Foot and Ankle Center, Plc | Podiatrist | 647 Dunlop Ln, Suite 209, Clarksville, TN 37040-5165 | 2009-06-10 |
| 1073748026 | Sarah Eisen Ellis | Anesthesiology | 647 Dunlop Ln, Suite 305, Clarksville, TN 37040-5165 | 2009-05-20 |
| 1437397007 | Matthew David Truscello | Podiatrist | 647 Dunlop Ln, 209, Clarksville, TN 37040-5165 | 2009-02-04 |
| 1538332010 | David E Smith | Podiatrist | 647 Dunlop Ln, Suite 209, Clarksville, TN 37040-5165 | 2008-04-07 |
| 1346301512 | Pamela Lynn Beasley | Nurse Practitioner | 647 Dunlop Ln, Suite 100 Medical Office Building One, Clarksville, TN 37040-5165 | 2006-12-12 |
| 1295742120 | Craig A Ennis | Internal Medicine | 647 Dunlop Ln, 210, Clarksville, TN 37040-5165 | 2006-08-02 |
| 1922044056 | Heidi R. Nussbaumer-story | Nurse Practitioner | 647 Dunlop Ln, Suite 100, Clarksville, TN 37040-5165 | 2006-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124380 | Clarksville Treatment Center, LLC | Clinic/Center | 495 Dunlop Lane, Clarksville, TN 37040 | 2019-10-04 |
| 1295384956 | Dena Marie Borchick | Technician | 3779 Cindy Jo Dr. N, Clarksville, TN 37040 | 2019-09-05 |
| 1477014488 | Emily Allen | Dentist | 930 Hwy 76, Clarksville, TN 37040 | 2019-03-31 |
| 1730640566 | Latoya Ewert | Counselor | Centerstone Clarksville Harriet Cohn Center, 511 8th Street, Clarksville, TN 37040 | 2019-03-26 |
| 1356811988 | Jamie Coles | Behavior Technician | 851 Professional Park Drive 851 Profesiional Park Drive, Clarksville, TN 37040 | 2018-11-27 |
| 1518448554 | Bandel Counseling Service | Clinic/Center | 113 3rd St., Suite 25, Clarksville, TN 37040 | 2018-08-28 |
| 1477052520 | Bridget Stokes | Behavior Technician | 2277 Wilma Rudolph Blvd., Suite C #259, Clarksville, TN 37040 | 2018-02-05 |
| 1053824334 | Sandra Loren Coates | Nurse Practitioner | 980 Professional Park Dr Ste C, Clarksville, TN 37040 | 2017-11-09 |
| 1902328362 | Terri Brooke Roach | Registered Nurse | 651 Dunlop Lane, Clarksville, TN 37040 | 2017-07-07 |
| 1093244428 | Nikkia Deneil Bell | Behavior Technician | 139 E. Old Trenton Rd, Suite B, Clarksville, TN 37040 | 2017-06-08 |
| Find all providers in zip 37040 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245295971 | Branch Medical Clinic Mid-south | Clinic/Center | 5722 Integrity Dr, Millington, TN 38054-5021 | 2006-04-18 |
| City | CLARKSVILLE |
| Zip Code | 37040 |
Please comment or provide details below to improve the information on BLANCHFIELD ARMY COMMUNITY HOSPITAL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.