Provider Demographics
NPI:1346302494
Name:EISENHOWER ARMY MEDICAL CENTER
Entity type:Organization
Organization Name:EISENHOWER ARMY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALS OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTIGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-787-2300
Mailing Address - Street 1:3395 HIGHLAND PARK PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4744
Mailing Address - Country:US
Mailing Address - Phone:901-233-7995
Mailing Address - Fax:
Practice Address - Street 1:3395 HIGHLAND PARK PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4744
Practice Address - Country:US
Practice Address - Phone:901-233-7995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC303584286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000Medicare UPIN