TMC SGT BLEAK-SILL
Complete NPI Record 1124234364
Clinic/Center - Military/U.S. Coast Guard Outpatient in Fort Sill, OK

Active since May 15, 2007

4301 MOW WAY ROAD, SGT BLEAK TROOP MEDICAL CLINIC, FORT SILL, OK 73503(580) 558-2800 Get Directions

NPPES record last updated: April 7, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Complete NPI Dataset

This page contains the complete raw NPPES record for Tmc Sgt Bleak-Sill (NPI 1124234364), a clinic/center organization in Fort Sill, OK. All 31 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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NPI: 1124234364: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: REYNOLDS ARMY COMMUNITY HOSPITAL: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: TMC SGT BLEAK-SILL: Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3: Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 3009 NW WILSON ROAD: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing Address: ATTN MCUA-PAD-PF: The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City Name: FORT SILL: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OK: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 735039042: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 5804582793: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider First Line Business Practice Location Address: 4301 MOW WAY ROAD: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SGT BLEAK TROOP MEDICAL CLINIC: The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: FORT SILL: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OK: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 73503: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5805582800: The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/15/2007: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 4/7/2015: The date that a record was last updated or changed.
Authorized Official Last Name: CHITTUM: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: CHARLES: The first name of the authorized official.
Authorized Official Title or Position: UBO MANAGER: The title or position of the authorized official.
Authorized Official Telephone Number: 5805582793: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 261QM1100X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Is Organization Subpart: Y: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Parent Organization LBN: REYNOLDS ARMY COMMUNITY HOSPITAL: The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
Parent Organization TIN: Not available: The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.

Other Provider Identifiers 2

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

VAD000 Medicare UPIN

1/2

Medicare UPIN (Unique Physician Identification Number): A legacy six-character alphanumeric identifier previously issued by Medicare to individual physicians before being retired and replaced by the NPI system.

OTH000 Medicare UPIN

2/2

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