NPIMap

Organization Active NPI

Branch Medical Clinic Naval Station San Diego

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • San Diego, CA
National Provider Identifier
1003006628
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO
Practice address
2450 Craven Steet
San Diego, CA 92136-5599
Phone
(619) 556-6302
Fax
(619) 556-9419
NPI assigned
Jul 30, 2007
Organization subpart
Yes
Parent organization
NAVAL MEDICAL CENTER SAN DIEGOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Michael Condon
Title
Navy Medicine Ubo Program Manager
Phone
(240) 401-3643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary

Addresses

Primary practice location

2450 Craven Steet
San Diego, CA 92136-5599

Mailing address

2450 Craven St
San Diego, CA 92136-5599
Phone (619) 556-6302

Other identifiers 1

IdentifierTypeStateIssuer
HSP63228FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Naval Medical Center San Diego26 organizations share this tax ID, including this one
Part of
Naval Medical Center San Diego

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

2450 Craven St
San Diego, CA 92136
Phone (619) 556-8101

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554336000000",
    "number": "1003006628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 CRAVEN ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921365599",
            "telephone_number": "619-556-6302",
            "fax_number": "619-556-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 CRAVEN STEET",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921365599",
            "telephone_number": "619-556-6302",
            "fax_number": "619-556-9419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NAVAL MEDICAL CENTER SAN DIEGO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2019-04-04",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "NAVY MEDICINE UBO PROGRAM MANAGER",
        "authorized_official_telephone_number": "240-401-3643",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP63228F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.