Provider Demographics
NPI:1942439476
Name:CREECH AID STATION
Entity type:Organization
Organization Name:CREECH AID STATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UNIFORM BUSINESS OFFICE PROGRAM MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-681-6303
Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-2015
Mailing Address - Fax:
Practice Address - Street 1:2D STREET BLDG #54
Practice Address - Street 2:
Practice Address - City:INDIAN SPRINGS
Practice Address - State:NV
Practice Address - Zip Code:89018
Practice Address - Country:US
Practice Address - Phone:702-404-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIKE O'CALLAGHAN FEDERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
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
NV2975742OtherNCPDP