# AHC MUNSON-LEAVENWORTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AHC MUNSON-LEAVENWORTH
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1366518433
- **Legal business name:** AHC MUNSON-LEAVENWORTH
- **Authorized official:** TONNESHA JEFFERSON (UBO MANAGER)
- **Authorized official phone:** (913) 684-6048

## Contact information

- **Practice address:** MUNSON ARMY HEALTH CENTER, 550 POPE AVENUE, FORT LEAVENWORTH, KS 66027
- **Practice address phone:** (913) 684-6000
- **Mailing address:** MUNSON ARMY HEALTH CENTER, 550 POPE AVENUE, FORT LEAVENWORTH, KS 66027
- **Mailing address phone:** (913) 684-6048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | — | Yes |
| 261QM1101X | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 05/21/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0547 | BCBS KS | — |
| 01 | — | 17-17125 | NCPDP | — |
| 01 | — | 883512 | BCBS KS | — |
| 01 | — | AN2598588 | MEDCO ID | — |