Provider Demographics
NPI:1922181627
Name:AHC R W BLISS-HUACHUCA
Entity type:Organization
Organization Name:AHC R W BLISS-HUACHUCA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLGENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-533-9685
Mailing Address - Street 1:2240 E WINROW AVE
Mailing Address - Street 2:ATTN MCXJ-RMD-MSAO
Mailing Address - City:FT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-7079
Mailing Address - Country:US
Mailing Address - Phone:520-533-9685
Mailing Address - Fax:
Practice Address - Street 1:2240 E WINROW AVE
Practice Address - Street 2:
Practice Address - City:FT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7079
Practice Address - Country:US
Practice Address - Phone:520-533-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHC R W BLISS-HUACHUCA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
03-24272OtherNCPDP
AN2598588OtherMEDCO PROVIDER ID
VAD000Medicare UPIN
03-24272OtherNCPDP