NPIMap

Organization Active NPI

Intrepid Spirit Concussion Recovery Center

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Camp Lejeune, NC
National Provider Identifier
1881168391
Registry record updated Jan 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
INTREPID SPIRIT CONCUSSION RECOVERY CENTER
Practice address
100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Phone
(910) 449-1100
NPI assigned
Jan 17, 2019
Organization subpart
Yes
Parent organization
NAVAL MEDICAL CENTER CAMP LEJEUNEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2019

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

100 Brewster Blvd
Camp Lejeune, NC 28547-2575

Mailing address

100 Brewster Blvd
Camp Lejeune, NC 28547-2575

National Provider Directory

National Provider Directory
Tax ID family
Branch Medical Clinic McAs New River25 organizations share this tax ID, including this one
Part of
Branch Medical Clinic McAs New River

Other organizations with this tax ID 24

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

View all 24

Locations

100 Brewster Blvd
Camp Lejeune, NC 28547
Phone (910) 450-4159

NPI Registry JSON

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

{
    "created_epoch": "1547683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547683200000",
    "number": "1881168391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BREWSTER BLVD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285472575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BREWSTER BLVD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285472575",
            "telephone_number": "910-449-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTREPID SPIRIT CONCUSSION RECOVERY CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NAVAL MEDICAL CENTER CAMP LEJEUNE",
        "enumeration_date": "2019-01-17",
        "last_updated": "2019-01-17",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "UBO MANAGER",
        "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 Camp Lejeune, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; 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.