Provider Demographics
NPI:1104925361
Name:EISENHOWER ARMY MEDICAL CENTER
Entity type:Organization
Organization Name:EISENHOWER ARMY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR PHRMCY OPERATIONS CNTR
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-221-8274
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:ATTN MCHF-PAD
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-1125
Mailing Address - Fax:
Practice Address - Street 1:BLDG 21
Practice Address - Street 2:
Practice Address - City:FT BUCHANAN
Practice Address - State:PR
Practice Address - Zip Code:00934
Practice Address - Country:US
Practice Address - Phone:787-740-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EISENHOWER ARMY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4022935OtherOTHER ID NUMBER-COMMERCIAL NUMBER