Organization
AHC MCDONALD-EUSTIS
Active
Parent organization
AHC MCDONALD-EUSTIS
Other names
AHC MCDONALD-EUSTIS
Organization subpart
Yes
Provider details
NPI number
Legal business name
AHC MCDONALD-EUSTIS
Authorized official
NA'KEESHA DE'BOSE (UBO MANAGER)
(757) 314-7500
Entity
Organization
Contact information
Practice address
579 JEFFERSON AVE, FORT EUSTIS, VA 23604
(757) 314-7500
Mailing address
579 JEFFERSON AVE, ATTN UBO, FORT EUSTIS, VA 23604
(757) 314-7770
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007316
TRIGON PROVIDER NUMBER
VA
01
—
266569
BLUE SHIELD PROVIDER NUMB
VA
01
—
4830419
NCPDP
—
Enumeration date
09/27/2006
Last updated
05/22/2025
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