KENNER ARMY HEALTH CLINIC (NPI# 1497036529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497036529 |
| Entity Type | Organization |
| Organization Name | KENNER ARMY HEALTH CLINIC |
| Other Organization Name | TMC-2 KENNER-FT LEE |
| Practice Address |
2601 C Ave Tmc 2 Bld T8204 Fort Lee VA 23801-1717 |
| Mailing Address |
700 24th St Attn Pad Fort Lee VA 23801-1716 |
| Practice Telephone | 8047349000 |
| Mailing Telephone | 8047349306 |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2014-01-30 |
| Authorized Official Name | CARLOS RODRIGUEZ-ROSADO (NCOIC PAD) |
| Authorized Official Telephone | 8047349299 |
| Is Organization Subpart | Y |
| Parent Organization Name | KENNER ARMY HEALTH CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PARENT FACILITY NPI | 1891854014 | 01 |
| Other Name | Type Code |
|---|---|
| TMC-2 Kenner-Ft Lee | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215218342 | Kenner Army Health Clinic | Clinic/Center | 8204 Ave C, Fort Lee, VA 23801-1716 | 2011-09-02 |
| 1982703013 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg 3219, Ft Lee, VA 23801 | 2006-09-22 |
| 1922107044 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg P8130, Ft Lee, VA 23801 | 2006-09-22 |
| 1417361866 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 700 24th St Bldg 8130, Kenner Army Health Clinic, Fort Lee, VA 23801-1716 | 2014-06-13 |
| 1043591175 | Kenner Army Health Clinic | Clinic/Center | 700 24th St, Bldg 3219 Ncxo Tmc, Fort Lee, VA 23801-1716 | 2011-09-02 |
| 1811285034 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 700 24th St, Kenner Army Health Clinic, Fort Lee, VA 23801-1716 | 2011-07-21 |
| 1689879330 | Kenner Army Health Clinic | Clinic/Center | 2601 C Ave, Fort Lee, VA 23801-1717 | 2007-06-20 |
| 1164640504 | Kenner Army Health Clinic | Clinic/Center | 700 24th St, Fort Lee, VA 23801-1716 | 2007-04-23 |
| 1891854014 | Kenner Army Health Clinic | Clinic/Center | 700 24th St, Fort Lee, VA 23801-1716 | 2006-12-06 |
| 1356330641 | Kenner Army Health Clinic | Clinic/Center | 700 24th St, Fort Lee, VA 23801-1716 | 2005-10-19 |
| Street Address |
2601 C AVE TMC 2 BLD T8204 |
| City | FORT LEE |
| State | VA |
| Zip Code | 23801-1717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205892775 | Sloan Gardiner Lanctot | Dentist | 2601 C Ave, Fort Lee, VA 23801-1717 | 2006-04-25 |
| 1770075772 | Amy S Woodfin | Dental Assistant | 2601 C Ave, Fort Lee, VA 23801-1717 | 2018-06-05 |
| 1457871097 | Jason J Hwang | Dentist | 2601 C Ave, Fort Lee, VA 23801-1717 | 2017-06-25 |
| 1245783620 | Alisha Holmes | Dental Hygienist | 2601 C Ave, Fort Lee, VA 23801-1717 | 2016-08-02 |
| 1295185734 | Antinia Day | Dental Hygienist | 2601 C Ave, Building 8204, Fort Lee, VA 23801-1717 | 2016-06-15 |
| 1902256589 | Thomas Rhinesmith | Dental Hygienist | 2601 C Ave, Fort Lee, VA 23801-1717 | 2016-06-15 |
| 1043660590 | Julliam Dones | Dental Hygienist | 2601 C Ave, Building 8204, Fort Lee, VA 23801-1717 | 2016-06-15 |
| 1528335973 | Chad Wayne Erickson | Dentist | 2601 C Ave, Fort Lee, VA 23801-1717 | 2011-11-29 |
| 1689879330 | Kenner Army Health Clinic | Clinic/Center | 2601 C Ave, Fort Lee, VA 23801-1717 | 2007-06-20 |
| 1992762249 | Michael Francis Larrimore | Dentist | 2601 C Ave, Us Army Dental Clinic Command, Fort Lee, VA 23801-1717 | 2006-04-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790262384 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | Ft. Lee 300 A Ave., Fort Lee, VA 23801 | 2018-07-26 |
| 1770812190 | Arkeye | Optometrist | 300 A Avenue, Bldg 1605, Fort Lee, VA 23801 | 2009-12-14 |
| 1992911044 | Claudis Andre' Williams Jr. | Physician Assistant | 700 24th St., Kenner Army Health Clinic, Ft. Lee, VA 23801 | 2007-05-15 |
| 1982703013 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg 3219, Ft Lee, VA 23801 | 2006-09-22 |
| 1922107044 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg P8130, Ft Lee, VA 23801 | 2006-09-22 |
| 1538135157 | Laurie Sue Giertz | Physician Assistant | 700 24th St Apt Hill, Fort Lee, VA 23801 | 2006-02-24 |
| 1689653396 | Robert Keith Lather | Emergency Medicine | Kenner Army Health Clinic, Primary Care Division, Ft Lee, VA 23801 | 2006-01-11 |
| 1265418370 | Edward Cathright Jr. | Dentist | 504 Trenton Drive, Fort Lee, VA 23801 | 2005-12-20 |
| 1801854807 | Mack Conley O'quinn Jr. | Social Worker | 700 24th Street, Kenner Army Health Clinic, Fort Lee, VA 23801 | 2006-05-02 |
| 1083690028 | Kimberly Ellen Newton | Registered Nurse | 700 24th Street, Usameddac Kahc Attn: Credentials Office, Fort Lee, VA 23801 | 2005-12-21 |
| Find all providers in zip 23801 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215218342 | Kenner Army Health Clinic | Clinic/Center | 8204 Ave C, Fort Lee, VA 23801-1716 | 2011-09-02 |
| 1043591175 | Kenner Army Health Clinic | Clinic/Center | 700 24th St, Bldg 3219 Ncxo Tmc, Fort Lee, VA 23801-1716 | 2011-09-02 |
| 1689879330 | Kenner Army Health Clinic | Clinic/Center | 2601 C Ave, Fort Lee, VA 23801-1717 | 2007-06-20 |
| 1891854014 | Kenner Army Health Clinic | Clinic/Center | 700 24th St, Fort Lee, VA 23801-1716 | 2006-12-06 |
| 1356330641 | Kenner Army Health Clinic | Clinic/Center | 700 24th St, Fort Lee, VA 23801-1716 | 2005-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801043252 | Kenner Ahc | Clinic/Center | 14115 Montague Rd, Fort A P Hill, VA 22427-3115 | 2008-08-27 |
| 1598958308 | Branch Medical Clinic The Basic School | Clinic/Center | 24008 Mcb #2, Quantico, VA 22134 | 2007-08-24 |
| 1821281908 | Branch Medical Clinic Ocs Brown Field | Clinic/Center | 2189 Elrod Ave, Building 5003, Quantico, VA 22134-5113 | 2007-08-22 |
| 1447457197 | Branch Medical Clinic Dahlgren | Clinic/Center | 192 Cassee Road, Bldg 192, Dahlgren, VA 22448-5000 | 2007-06-27 |
| 1821294729 | Mcdonald Army Health Center | Clinic/Center | Building 82 Ingals, Fort Monroe, VA 23651 | 2007-06-26 |
| 1659577534 | Mcdonald Army Health Center | Clinic/Center | Building 576 Stemberg Avenue, Fort Eustis, VA 23604 | 2007-06-26 |
| 1508062779 | Mcdonald Army Health Center | Clinic/Center | Building 669 Monroe Avenue, Fort Eustis, VA 23604 | 2007-06-25 |
| 1356426894 | United States Coast Guard | Clinic/Center | End of Route 238, Yorktown, VA 23690-5000 | 2006-10-25 |
| 1922199066 | Mcdonald Army Health Center | Clinic/Center | 579 Jefferson Ave, Fort Eustis, VA 23604 | 2006-09-27 |
| 1821501719 | Tricare Medical Clinic Suffolk | Clinic/Center | 1317 Ballahack Rd, Chesapeake, VA 23322-2499 | 2017-11-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.