Organization
AHC R W BLISS-HUACHUCA
Active
Parent organization
AHC R W BLISS-HUACHUCA
Other names
AHC R W BLISS-HUACHUCA
Organization subpart
Yes
Provider details
NPI number
Legal business name
AHC R W BLISS-HUACHUCA
Authorized official
JESTINE VOLGENDE (UBO MANAGER)
(520) 533-9685
Entity
Organization
Contact information
Practice address
2240 E WINROW AVE, FT HUACHUCA, AZ 85613-7079
(520) 533-0447
Mailing address
2240 E WINROW AVE, ATTN MCXJ-RMD-MSAO, FT HUACHUCA, AZ 85613-7079
(520) 533-9685
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-24272
NCPDP
—
01
—
AN2598588
MEDCO PROVIDER ID
—
Enumeration date
10/24/2006
Last updated
05/21/2025
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