Provider Demographics
NPI:1386604387
Name:NAVAL HOSPITAL CAMP PENDLETON
Entity type:Organization
Organization Name:NAVAL HOSPITAL CAMP PENDLETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:PETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-725-1621
Mailing Address - Street 1:PO BOX 555191
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5191
Mailing Address - Country:US
Mailing Address - Phone:760-725-1621
Mailing Address - Fax:760-725-1661
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:FIN MGMT CODE 0814
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-1621
Practice Address - Fax:760-725-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP45020FMedicaid
CAHSM35020FMedicaid
CAHSP35020FMedicaid
CA05020FMedicare ID - Type Unspecified