Organization
WILFORD HALL MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DARLENE JACKSON (CREDENTIALS MANAGER)
(210) 292-6707
Entity
Organization
Contact information
Practice address
2200 BERGQUIST DR, ATTN: CREDENTIALS (CMC), LACKLAND A F B, TX 78236-9907
(210) 292-6707
(210) 292-7964
Mailing address
9911 STONEFIELD PL, SAN ANTONIO, TX 78254-6749
(210) 706-9393
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
40761
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40761
LCSW LICENSE NUMBER
TX
01
—
70319P
WHMC PROVIDER NUMBER
TX
Enumeration date
02/21/2006
Last updated
08/22/2020
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