USA Meddac, Rwbach

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

LCSW 0611 Issued in AZ

Legal business name

USA MEDDAC, RWBACH

Practice address

2240 Winrow Ave
Fort Huachuca, AZ 85613

Phone

(520) 533-2071

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Joseph A Bubala, LCSW, LISAC

Title

Clinical Director, Asap

Phone

(520) 533-2071

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1881779353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 WINROW AVE",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "85613",
            "telephone_number": "520-533-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 WINROW AVE",
            "city": "FORT HUACHUCA",
            "state": "AZ",
            "postal_code": "85613",
            "telephone_number": "520-533-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "USA MEDDAC, RWBACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-19",
        "status": "A",
        "authorized_official_last_name": "BUBALA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR, ASAP",
        "authorized_official_telephone_number": "520-533-2071",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW, LISAC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "AZ",
            "license": "LCSW 0611",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "AZ",
            "license": "LISAC 1029",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Thomas, LPN
• Debra A Thornby
• Rachel Tripp
• David W Trull, OD
• Stephanie Tyson
• USA Meddac, Rwbahc
• USA Meddac, Rwbahc
• USA Meddac,Rwbahc
• Raul Valenzuela, PHARMD
• M Denise Valle

• Substance Use Disorder Rehabilitation Clinic/Center in Fort Huachuca, AZ
• Providers in Fort Huachuca, AZ by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; 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.