NPIMap

Organization Active NPI

United States Navy

  • Operational (Transportable) Military General Acute Care Hospital
  • Ballwin, MO
National Provider Identifier
1730249079
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Operational (Transportable) Military General Acute Care HospitalTaxonomy code 2865X1600X
License
064569 Issued in MO
Legal business name
UNITED STATES NAVY
Practice address
704 Guenevere Dr
Ballwin, MO 63011-3525
Phone
(636) 386-2729
Fax
(636) 527-8189
NPI assigned
Dec 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gary George Nitz, CRNA
Title
Nurse Anesthetist
Phone
(314) 518-9118

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Operational (Transportable) Military General Acute Care Hospital 2865X1600X 064569 MO Primary

Addresses

Primary practice location

704 Guenevere Dr
Ballwin, MO 63011-3525

Mailing address

704 Guenevere Dr
Ballwin, MO 63011-3525
Phone (636) 386-2729

National Provider Directory

National Provider Directory
Tax ID family
Dfas-Cljflp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730249079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 GUENEVERE DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630113525",
            "telephone_number": "636-386-2729",
            "fax_number": "636-527-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 GUENEVERE DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630113525",
            "telephone_number": "636-386-2729",
            "fax_number": "636-527-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED STATES NAVY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NITZ",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "NURSE ANESTHETIST",
        "authorized_official_telephone_number": "314-518-9118",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "2865X1600X",
            "taxonomy_group": "",
            "desc": "Military Hospital, Military General Acute Care Hospital. Operational (Transportable)",
            "state": "MO",
            "license": "064569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballwin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.