EISENHOWER ARMY MEDICAL CENTER (NPI# 1164636320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164636320 |
| Entity Type | Organization |
| Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Other Organization Name | SOUTHCOM CLINIC-FT. GORDON |
| Practice Address |
3511 Nw 91st Ave Doral FL 33172-1216 |
| Mailing Address |
300 W Hospital Rd Bldg W Attn Mchf-pad Fort Gordon GA 30905-5741 |
| Practice Telephone | 3054371970 |
| Mailing Telephone | 7067871125 |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2015-01-05 |
| Authorized Official Name | MARVIN PRIMOS (UBO MANAGER) |
| Authorized Official Telephone | 7067877204 |
| Is Organization Subpart | Y |
| Parent Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PARENT MTF NPI | 1578660742 | 01 |
| Other Name | Type Code |
|---|---|
| SOUTHCOM CLINIC-FT. GORDON | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548672173 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Rodriguez Army Health Clinic (rahc), Bldg 21 Chrisman Rd., Fort Buchanan, PR 00934-3400 | 2014-06-02 |
| 1053661173 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Building 21, 21 Chrisman Rd, Ft Buchanan, PR 00934-3400 | 2012-09-17 |
| 1588868848 | Eisenhower Army Medical Center | Clinic/Center | 320 Hospital Road, Fort Gordon, GA 30905 | 2007-06-12 |
| 1396949657 | Eisenhower Army Medical Center | Clinic/Center | Building 25501, Brainard Avenue, Fort Gordon, GA 30905 | 2007-06-12 |
| 1619170198 | Eisenhower Army Medical Center | Clinic/Center | 1701 Hardee Avenue, S.w., Fort Mcpherson, GA 30330 | 2007-06-11 |
| 1750584363 | Eisenhower Army Medical Center | Clinic/Center | 1450 14th St, Hattiesburg, MS 39407-0001 | 2007-06-10 |
| 1104031194 | Eisenhower Army Medical Center | Clinic/Center | 1001 Hardy St, Hattiesburg, MS 39401-4165 | 2007-05-11 |
| 1346302494 | Eisenhower Army Medical Center | Military Hospital | 3395 Highland Park Pl, Memphis, TN 38111-4744 | 2006-12-15 |
| 1427131432 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 29709 B Street, Fort Gordon, GA 30905-5741 | 2006-10-23 |
| 1104925361 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Bldg 21, Ft Buchanan, PR 00934 | 2006-09-22 |
| Street Address |
3511 NW 91ST AVE |
| City | DORAL |
| State | FL |
| Zip Code | 33172-1216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033102710 | Victor Luis Ortiz | Family Medicine | 3511 Nw 91st Ave, Ussouthcom, Doral, FL 33172-1216 | 2005-08-26 |
| 1356619423 | Quality Managed Health Crae, Inc. | Chiropractor | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2011-12-05 |
| 1225187974 | Michael Coote | Physician Assistant | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2007-01-10 |
| 1003977042 | Rene' Janelle Chadwell | Physician Assistant | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2006-12-13 |
| 1881789956 | Beverly Caren Land | Family Medicine | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2006-10-04 |
| 1477650224 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2006-09-20 |
| 1588646640 | Edwin Xavier Gutierrez | Physician Assistant | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2005-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801366463 | Magela De Las Mercedes Rodriguez | Behavior Technician | 11252 Nw 6 Street, Miami, FL 33172 | 2018-11-27 |
| 1477030666 | Natacha Garcia | Behavior Technician | 181 Nw 97 Ave Apto 416, Miami, FL 33172 | 2018-07-20 |
| 1720578701 | Marisela Hernandez | Behavioral Analyst | 10825 Nw 7th St Apt 12, Miami, FL 33172 | 2018-05-15 |
| 1083113054 | Fuerza Vital Medical Institute, Corp | Speech-Language Pathologist | 8725 Nw 18 Terr Suite 209, Doral, FL 33172 | 2018-02-06 |
| 1063923522 | Kristen Nicole Otero | Counselor | 1414 Nw 107 Ave Suite 109, Doral, FL 33172 | 2017-10-23 |
| 1003327339 | All Orthopedic Supplies Corp | Prosthetic/Orthotic Supplier | 175 Fontainbleau Blvd, Ste P1, Miami, FL 33172 | 2017-10-13 |
| 1861901944 | Lyanne M Melendez | Speech-Language Pathologist | 1750 Nw 107 Ave, Unit P-901, Miami, FL 33172 | 2017-09-21 |
| 1295259166 | Family Tender Care Services Inc | Behavioral Analyst | 9360 Fontainebleau Blvd, Unit 514, Miami, FL 33172 | 2017-08-01 |
| 1992229074 | Maria F Palabez | Behavior Technician | 9369 Fontainebleau Blvd J225, Miami, FL 33172 | 2017-07-31 |
| 1700306602 | Jenny Lemus | Behavior Technician | 10200 Nw 25th St Suite 205, Doral, FL 33172 | 2017-06-21 |
| Find all providers in zip 33172 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
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| 1164679601 | Martin Army Community Hospital | Clinic/Center | 6069 Walkers Ln, Tmc 12 Camp Rudder, Eglin Afb, FL 32542-8505 | 2008-08-27 |
| 1114117173 | Branch Medical Clinic Panama City | Clinic/Center | 6703 W Highway 98, Panama City, FL 32407-7000 | 2007-07-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.