GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL (NPI# 1548656044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548656044 |
| Entity Type | Organization |
| Organization Name | GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL |
| Other Organization Name | USADC BOAK-LEONARD WOOD |
| Practice Address |
12720 Kansas Ave Bldg 789 Fort Leonard Wood MO 65473 |
| Mailing Address |
4430 Missouri Ave Attn Mcxp Rmd Ub Box 1242 Fort Leonard Wood MO 65473-9098 |
| Practice Telephone | 5735960388 |
| Mailing Telephone | 5735960494 |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2015-09-25 |
| Authorized Official Name | CRAIG PEEL (UBO MANAGER) |
| Authorized Official Telephone | 5735960494 |
| Is Organization Subpart | Y |
| Parent Organization Name | GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL |
| 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 |
| Other Name | Type Code |
|---|---|
| USADC BOAK-LEONARD WOOD | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366812091 | General Leonard Wood Army Community Hospital | Clinic/Center | 7621 Big Piney Rd, Fort Leonard Wood, MO 65473-1572 | 2015-10-07 |
| 1568762110 | General Leonard Wood Army Community Hospital | Military Hospital | 126 Missouri Ave., Fort Leonard Wood, MO 65473 | 2010-10-29 |
| 1942529961 | General Leonard Wood Army Community Hospital | Clinic/Center | 194 Eastlawn Ave, Suite D, Saint Robert, MO 65584-3701 | 2010-06-01 |
| 1700081700 | General Leonard Wood Army Community Hospital | Clinic/Center | West 4th and Virginia Street, Fort Leonard Wood, MO 65473 | 2007-06-19 |
| 1114133923 | General Leonard Wood Army Community Hospital | Clinic/Center | 4300 Goodfellow Blvd, Goodfellow Complex Bldg 103d, Saint Louis, MO 63120-1703 | 2007-05-16 |
| 1033325840 | General Leonard Wood Army Community Hospital | Clinic/Center | Alabama Avenue Bldg 885, Fort Leonard Wood, MO 65473-8952 | 2007-05-16 |
| 1306945738 | General Leonard Wood Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 4430 Missouri Ave Bldg 360, Fort Leonard Wood, MO 65473-9098 | 2006-09-22 |
| 1225083249 | General Leonard Wood Army Community Hospital | Clinic/Center | 4430 Missouri Ave, Fort Leonard Wood, MO 65473-9098 | 2006-05-24 |
| 1275920076 | General Leonard Wood Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 4430 Missouri Ave, General Leonard Wood Ach, Fort Leonard Wood, MO 65473-9098 | 2015-04-20 |
| 1548657612 | General Leonard Wood Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 4430 Missouri Ave, Glwach Pharmacy, Fort Leonard Wood, MO 65473-9098 | 2015-04-16 |
| Street Address |
12720 KANSAS AVE BLDG 789 |
| City | FORT LEONARD WOOD |
| State | MO |
| Zip Code | 65473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902352743 | Jill Stephanie Simono | Dental Assistant | 12720 Kansas Ave, Bldg 789, Fort Leonard Wood, MO 65473 | 2016-08-31 |
| 1851847131 | Debra L Vine | Dental Assistant | 12720 Kansas Ave, Bldg 789, Fort Leonard Wood, MO 65473 | 2016-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770192759 | Clara Boo Chai | Physician Assistant | General Leonard Wood Army Community Hospital, 4430 Missouri Ave, #1267, Fort Leonard Wood, MO 65473 | 2020-07-27 |
| 1982198453 | Traci Anne Shambo | Dental Hygienist | Bldg. 400 Virginia Ave, Fort Leonard Wood, MO 65473 | 2018-06-19 |
| 1083133771 | Mary Joan Klemp | Family Medicine | Ganeral Leonard Wood Army Community Hospital, 4430 Missouri Ave; Meddac Case Management; Primary Care, Fort Leonard Wood, MO 65473 | 2017-09-13 |
| 1255791851 | Sarah Elizabeth Joy | Physician Assistant | 885 West 16th Street, Fort Leonard Wood, MO 65473 | 2016-02-25 |
| 1548626948 | Jaimie-lee Musen | Physical Therapist | 4430 Missouri Ave, Glwach, Fort Leonard Wood, MO 65473 | 2016-01-14 |
| 1609240852 | Angela Carson | Registered Nurse | 4330 Missouri Avenue, Fort Leonard Wood, MO 65473 | 2015-11-25 |
| 1811379407 | Katharine Leigh Stringer | Dentist | 12720 Kansas Avenue, Fort Leonard Wood, MO 65473 | 2015-06-19 |
| 1740670314 | Terricka Stewart | Specialist/Technologist | 885 West 16th St., Fort Leonard Wood, MO 65473 | 2015-02-03 |
| 1427467265 | Dianna Morrison | Social Worker | 4430 Missouri Ave Box 1278, Fort Leonard Wood, MO 65473 | 2014-08-06 |
| 1265848634 | Rachel Lopp | Specialist/Technologist | Bld 901, Room 131, Fort Leonard Wood, MO 65473 | 2014-07-07 |
| Find all providers in zip 65473 | ||||
| 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 |
|---|---|---|---|---|
| 1366812091 | General Leonard Wood Army Community Hospital | Clinic/Center | 7621 Big Piney Rd, Fort Leonard Wood, MO 65473-1572 | 2015-10-07 |
| 1700081700 | General Leonard Wood Army Community Hospital | Clinic/Center | West 4th and Virginia Street, Fort Leonard Wood, MO 65473 | 2007-06-19 |
| 1033325840 | General Leonard Wood Army Community Hospital | Clinic/Center | Alabama Avenue Bldg 885, Fort Leonard Wood, MO 65473-8952 | 2007-05-16 |
| 1063617272 | General Leonard Wood Army Community Hospital | Clinic/Center | 126 Missouri Ave, Usadc, Fort Leonard Wood, MO 65473-8952 | 2007-06-18 |
| 1760687214 | General Leonard Wood Army Community Hospital | Clinic/Center | 1724 Nebraska Ave, Building 1608, Fort Leonard Wood, MO 65473-8939 | 2007-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952804668 | Equi-librium Therapy Center | Clinic/Center | 1148 S Courtney Ln, Rogersville, MO 65742-4501 | 2018-03-09 |
| 1942529961 | General Leonard Wood Army Community Hospital | Clinic/Center | 194 Eastlawn Ave, Suite D, Saint Robert, MO 65584-3701 | 2010-06-01 |
| 1114133923 | General Leonard Wood Army Community Hospital | Clinic/Center | 4300 Goodfellow Blvd, Goodfellow Complex Bldg 103d, Saint Louis, MO 63120-1703 | 2007-05-16 |
| 1861605404 | Munson Army Health Center | Clinic/Center | 15431 Andrews Rd, Kansas City, MO 64147-1221 | 2007-05-08 |
| City | FORT LEONARD WOOD |
| Zip Code | 65473 |
Please comment or provide details below to improve the information on GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL.
| 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.