EISENHOWER ARMY MEDICAL CENTER (NPI# 1366997108) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366997108 |
| Entity Type | Organization |
| Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Other Organization Name | DOD SOUTHCOM EPHCY |
| Practice Address |
9301 Nw 33rd St Army Health Clinic Southcom Doral FL 33172-1202 |
| Mailing Address |
Eisenhower Army Medical Center 300 W Hospital Rd Attn: Mchf-pad Ft Gordon GA 30905-5741 |
| Practice Telephone | 3054371749 |
| Practice Fax Number | 3054371149 |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2016-08-22 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2163700 | 01 |
| Other Name | Type Code |
|---|---|
| DoD SOUTHCOM ePhcy | 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 |
9301 NW 33RD ST ARMY HEALTH CLINIC SOUTHCOM |
| City | DORAL |
| State | FL |
| Zip Code | 33172-1202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669456331 | Javier Ditas | Physician Assistant | 9301 Nw 33rd St, Doral, FL 33172-1202 | 2005-12-05 |
| 1245773985 | Brenda Delois Adams | Registered Nurse | 9301 Nw 33rd St, Doral, FL 33172-1202 | 2016-11-29 |
| 1417304296 | Hilda Funez-escobar | Nurse Practitioner | 9301 Nw 33rd St, Doral, FL 33172 | 2016-05-20 |
| 1568725414 | Elizabeth J Carp Bernotavicius | Pharmacist | 9301 Nw 33rd St, Doral, FL 33172-1202 | 2012-06-15 |
| 1184810178 | Sarah Ann Spar Alexander | Psychologist | 9301 Nw 33rd St, Installation Services Building; Suite A1040., Doral, FL 33172-1202 | 2007-09-24 |
| 1457323644 | Angel Aurelio Guerra | Internal Medicine | 9301 Nw 33rd St, Doral, FL 33172-1202 | 2006-02-02 |
| 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 | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164636320 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2007-05-09 |
| 1477650224 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 3511 Nw 91st Ave, Doral, FL 33172-1216 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114425113 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 2500 Veterans Way, Bldg 645, Panama City, FL 32408 | 2018-01-25 |
| 1134518798 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 3120 A. Talon Way, Eglin Afb Fld #3, FL 32542 | 2015-01-20 |
| 1457764078 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 5820 W Highway 98, Pensacola, FL 32507-1072 | 2014-06-11 |
| 1437562626 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 7119 Langley St Bldg 2985, Milton, FL 32570-6105 | 2014-06-05 |
| 1932512498 | Mayport Refill Pharmacy | Military/U.S. Coast Guard Pharmacy | Naval Health Clinic Mayport, 2104 Massey Ave, Mayport, FL 32228 | 2014-06-03 |
| 1770995300 | Jacksonville Refill Pharmacy | Military/U.S. Coast Guard Pharmacy | Navy Exchange Pharmacy, Bldg 950, Jacksonville, FL 32214-5000 | 2014-06-02 |
| 1598177123 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 96 Medical Group Satellite Phcy Memorial Trail, Bldg. 1758, Eglin Afb, FL 32542 | 2014-06-02 |
| 1518301696 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 5820 West Highway 98, Bldg 3737, Pensacola, FL 32507 | 2013-04-19 |
| 1356653844 | Us Coast Guard Finance Center | Military/U.S. Coast Guard Pharmacy | 100 Trumbo Point Road, Key West, FL 33040 | 2010-07-13 |
| 1518051093 | Hrs Citrus County Health Dept. Pharmacy | Military/U.S. Coast Guard Pharmacy | 2804 Marc Knighton Ct, Lecanto, FL 34461 | 2006-10-02 |
| 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.