Provider Demographics
NPI:1548672173
Name:AMC EISENHOWER
Entity type:Organization
Organization Name:AMC EISENHOWER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
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:210-536-6650
Mailing Address - Street 1:EISENHOWER ARMY MEDICAL CENTER
Mailing Address - Street 2:C/O ATTN MCHF-PAD 300 W HOSPITAL ROAD
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:787-707-2319
Mailing Address - Fax:787-707-2591
Practice Address - Street 1:RODRIGUEZ ARMY HEALTH CLINIC (RAHC)
Practice Address - Street 2:BLDG 21 CHRISMAN RD.
Practice Address - City:FORT BUCHANAN
Practice Address - State:PR
Practice Address - Zip Code:00934-3400
Practice Address - Country:US
Practice Address - Phone:787-707-2319
Practice Address - Fax:787-707-2591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMC EISENHOWER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-02
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145989OtherPK