Eisenhower Army Medical Center
Organization Active NPI Military/U.S. Coast Guard Outpatient Clinic/Center · Doral, FL
NPI 1164636320 · NPPES record last updated Jan 5, 2015
Key facts
- NPI
- 1164636320
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X
- Legal business name
- EISENHOWER ARMY MEDICAL CENTER
- Practice address
- 3511 NW 91St Ave
Doral, FL 33172-1216 - Phone
- (305) 437-1970
- NPI assigned
- May 9, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- EISENHOWER ARMY MEDICAL CENTER
Authorized official
- Name
- Marvin Primos
- Title
- Ubo Manager
- Phone
- (706) 787-7204
Corporate family (same tax ID) 15
National Provider Directory
- Tax ID family
- AMC Eisenhower
- Part of
- AMC Eisenhower
Locations
3511 NW 91st Ave
Doral, FL 33172
Phone (305) 437-1148
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military/U.S. Coast Guard Outpatient Clinic/Center | 261QM1100X | Yes | ||
| Military/U.S. Coast Guard Pharmacy | 332000000X |
Addresses
Primary practice location
3511 NW 91St Ave
Doral, FL 33172-1216
Mailing address
300 W Hospital Rd BLDG W
Attn MCHF-Pad
Fort Gordon, GA 30905-5741
Phone (706) 787-1125
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578660742 | Other | PARENT MTF NPI |
Other names
- SOUTHCOM CLINIC-FT. GORDON
Other providers in Doral, FL
- Egd Behavior Therapies LLC
- Daniela Melanie Eguino
- Gary Walter Ehlert Birriel Jr.
- Emma Katherine Eilo
- Stacey Eisdorfer
- Daniela Eizmendiz
- Eki Pharmacy Inc
- El Doral Assited Living
- Stella Elberg
- Electric Mobility Corporation
All providers in Doral, FL · Military/U.S. Coast Guard Outpatient Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.