Organization
X AWAITING INACTIVATION3
Active
Parent organization
X AWAITING INACTIVATION3
Organization subpart
Yes
Provider details
NPI number
Legal business name
X AWAITING INACTIVATION3
Authorized official
WILLIAM MICHAEL CONDON (UBO)
(240) 401-3643
Entity
Organization
Contact information
Practice address
301DUSTOFF AVE, LYSTER ARMY HEALTH CLINIC, FORT RUCKER, AL 36362-5333
(334) 255-7755
(334) 255-7368
Mailing address
301DUSTOFF AVE, LYSTER ARMY HEALTH CLINIC, FORT RUCKER, AL 36362-5333
(334) 255-7755
(334) 255-7368
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
B1614161
AL
Other
Enumeration date
10/01/2008
Last updated
06/30/2025
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