NPIMap

Organization Active NPI

Eisenhower Army Medical Center

Doing business as Gordon PX Phcy

  • Military/U.S. Coast Guard Pharmacy
  • Fort Gordon, GA
National Provider Identifier
1306945076
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
EISENHOWER ARMY MEDICAL CENTER
Doing business as
Gordon PX Phcy
Practice address
3Rd Avenue
BLDG 38200
Ft Gordon, GA 30905
Phone
(706) 787-6155
Fax
(706) 787-6175
NPI assigned
Sep 21, 2006
Last updated
Jun 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Authorized official

Name
Hector Morales
Title
Chief Dha Pass
Phone
(210) 536-6650

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Pharmacy 332000000X NU Primary

Addresses

Primary practice location

3Rd Avenue
BLDG 38200
Ft Gordon, GA 30905

Mailing address

300 W Hospital Rd
Attn MCHF-Pad
Fort Gordon, GA 30905-5741
Phone (706) 787-6155

Other identifiers 1

IdentifierTypeStateIssuer
2020248OtherPK

Other names 1

  • GORDON PX PHCY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
AMC Eisenhower-Gordon3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1306945076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL RD",
            "address_2": "ATTN MCHF-PAD",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055741",
            "telephone_number": "706-787-6155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3RD AVENUE",
            "address_2": "BLDG 38200",
            "city": "FT GORDON",
            "state": "GA",
            "postal_code": "30905",
            "telephone_number": "706-787-6155",
            "fax_number": "706-787-6175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EISENHOWER ARMY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "CHIEF DHA PASS",
        "authorized_official_telephone_number": "210-536-6650"
    },
    "taxonomies": [
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2020248",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GORDON PX PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Gordon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; 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.