NPIMap

Organization Active NPI

Branch Medical Clinic Camp Smith Medical Annex

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Pearl Harbor, HI
National Provider Identifier
1073712824
Registry record updated Nov 17, 2017
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 CAMP SMITH MEDICAL ANNEX
Practice address
480 Central Ave
Code 02
Pearl Harbor, HI 96860-4908
Phone
(808) 474-2239
NPI assigned
Jul 12, 2007
Organization subpart
Yes
Parent organization
NAVAL HEALTH CLINIC HAWAIIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2017

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

Authorized official

Name
William M Condon
Title
Bumed Ubo
Phone
(240) 401-3643

Specialties & licenses 1

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

Addresses

Primary practice location

480 Central Ave
Code 02
Pearl Harbor, HI 96860-4908

Mailing address

480 Central Ave
Code 02
Pearl Harbor, HI 96860-4908

National Provider Directory

National Provider Directory
Tax ID family
Branch Medical Clinic Annex Wahiawa7 organizations share this tax ID, including this one
Part of
Branch Medical Clinic Annex Wahiawa

Other organizations with this tax ID 6

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

Locations

480 Central Ave
#2
Pearl Harbor, HI 96860
Phone (808) 474-2239

NPI Registry JSON

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1073712824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE",
            "address_2": "CODE 02",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "968604908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE",
            "address_2": "CODE 02",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-474-2239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANCH MEDICAL CLINIC CAMP SMITH MEDICAL ANNEX",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NAVAL HEALTH CLINIC HAWAII",
        "enumeration_date": "2007-07-12",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUMED UBO",
        "authorized_official_telephone_number": "240-401-3643"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearl Harbor, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; 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.