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Eisenhower Army Medical Center

Organization Active NPI Military/U.S. Coast Guard Outpatient Clinic/Center · Fort Gordon, GA

NPI 1396949657 · NPPES record last updated Jan 29, 2013

Key facts

NPI
1396949657
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
Building 25501, Brainard Avenue
Fort Gordon, GA 30905
Phone
(706) 787-7050
NPI assigned
Jun 12, 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

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

Practitioners 1

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

National Provider Directory

Tax ID family
AMC Eisenhower (16 organizations share this tax ID)
Part of
AMC Eisenhower

Specialties & licenses

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

Addresses

Primary practice location

Building 25501, Brainard Avenue
Fort Gordon, GA 30905

Mailing address

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

Other names

  • USADC FT. GORDON SNYDER Doing business as

Other providers in Fort Gordon, GA

All providers in Fort Gordon, GA · Military/U.S. Coast Guard Outpatient Clinic/Center in Georgia

Sources for this page

Verify at the official NPI Registry.