| Us Army | |
|
Madigan Army Medical Ctr 9040 Jackson Ave Tacoma WA 98431-0001 | |
| (253) 968-1110 | |
| Not Available |
| Full Name | Us Army |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | Madigan Army Medical Ctr, Tacoma, Washington |
| Authorized Official Name and Position | Kimberly Ann Genkov (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 2489097531 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Us Army 800 Roe St Steilacoom WA 98388-4006 Ph: (248) 909-7531 | Us Army Madigan Army Medical Ctr 9040 Jackson Ave Tacoma WA 98431-0001 Ph: (253) 968-1110 |
| NPI Number | 1710429279 |
|---|---|
| Provider Enumeration Date | 11/14/2016 |
| Last Update Date | 11/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710429279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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