# US ARMY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366423741
- **Authorized official:** TED CIESLACK MD (CHIEF PEDIATRICS)
- **Authorized official phone:** (210) 916-0707

## Contact information

- **Practice address:** 2200 BERGQUIST DR, LACKLAND A F B, TX 78236-9907
- **Practice address phone:** (210) 292-0427
- **Mailing address:** 2200 BERGQUIST DR, LACKLAND A F B, TX 78236-9907
- **Mailing address phone:** (210) 292-0427

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 286500000X | Military Hospital | M1366 | TX | Yes |

## Other

- **Enumeration date:** 11/11/2005
- **Last updated:** 08/22/2020