NPIMap

Organization Active NPI

Eisenhower Army Medical Center

Doing business as Camp Shelby

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Hattiesburg, MS
National Provider Identifier
1104031194
Registry record updated Jan 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
EISENHOWER ARMY MEDICAL CENTER
Doing business as
Camp Shelby
Practice address
1001 Hardy St
Hattiesburg, MS 39401-4165
Phone
(706) 787-5811
NPI assigned
May 11, 2007
Last updated
Jan 29, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
EISENHOWER ARMY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 29, 2013

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

Authorized official

Name
Marvin Primos
Title
Ubo Manager
Phone
(706) 787-7204

Specialties & licenses 1

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

Addresses

Primary practice location

1001 Hardy St
Hattiesburg, MS 39401-4165

Mailing address

300 W Hospital Rd BLDG W
Attn MCHF-Pad
Fort Gordon, GA 30905-5741
Phone (706) 787-1125

Other names 1

  • CAMP SHELBY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
AMC Eisenhower16 organizations share this tax ID, including this one
Part of
AMC Eisenhower

Other organizations with this tax ID 15

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

View all 15

Locations

1001 Hardy St
Hattiesburg, MS 39401

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359417600000",
    "number": "1104031194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL RD BLDG W",
            "address_2": "ATTN MCHF-PAD",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055741",
            "telephone_number": "706-787-1125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 HARDY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014165",
            "telephone_number": "706-787-5811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EISENHOWER ARMY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EISENHOWER ARMY MEDICAL CENTER",
        "enumeration_date": "2007-05-11",
        "last_updated": "2013-01-29",
        "status": "A",
        "authorized_official_last_name": "PRIMOS",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "UBO MANAGER",
        "authorized_official_telephone_number": "706-787-7204"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAMP SHELBY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; 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.