Provider Demographics
NPI:1922199066
Name:AHC MCDONALD-EUSTIS
Entity type:Organization
Organization Name:AHC MCDONALD-EUSTIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NA'KEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE'BOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-314-7500
Mailing Address - Street 1:579 JEFFERSON AVE
Mailing Address - Street 2:ATTN UBO
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604
Mailing Address - Country:US
Mailing Address - Phone:757-314-7770
Mailing Address - Fax:
Practice Address - Street 1:579 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604
Practice Address - Country:US
Practice Address - Phone:757-314-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AHC MCDONALD-EUSTIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007316OtherTRIGON PROVIDER NUMBER
VA266569OtherBLUE SHIELD PROVIDER NUMB
4830419OtherNCPDP
VA266569OtherBLUE SHIELD PROVIDER NUMB
4830419OtherNCPDP
4830419OtherNCPDP