# U.S. NAVY

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

## Provider details

- **NPI number:** 1477564870
- **Authorized official:** EDWARD THEODORE MILLER IDC (INDEPENDENT DUTY CORPSMAN)
- **Authorized official phone:** (860) 634-2876

## Contact information

- **Practice address:** BOX 159 NAVSUBASENLON, NAVAL UNDERSEA MEDICAL INSTITUTE, GROTON, CT 06340-5159
- **Practice address phone:** (860) 694-2876
- **Practice address fax:** (860) 694-3696
- **Mailing address:** PO BOX 159, BOX 159 NAVSUBASENLON, GROTON, CT 06340-5159
- **Mailing address phone:** (860) 694-2876
- **Mailing address fax:** (860) 694-3696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1710I1002X | Independent Duty Corpsman | — | NULL | Yes |
| 1710I1002X | Independent Duty Corpsman | — | — | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 08/22/2020