BRANCH MEDICAL CLINIC GULFPORT (NPI# 1558773192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558773192 |
| Entity Type | Organization |
| Organization Name | BRANCH MEDICAL CLINIC GULFPORT |
| Practice Address |
5502 Marvin Shields Blvd Gulfport MS 39501 |
| Mailing Address |
Naval Hospital Pensacola 6000 W Hwy 98 Code 11 Pensacola FL 32512-0003 |
| Practice Telephone | 2288225783 |
| Practice Fax Number | 2288713648 |
| Mailing Telephone | 2288225784 |
| Mailing Fax Number | 2288712135 |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2019-11-13 |
| Authorized Official Name | WILLIAM M CONDON (BUMED UBO) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL HOSPITAL PENSACOLA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2146016 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194824516 | Branch Medical Clinic Gulfport | Military/U.S. Coast Guard Pharmacy | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2006-09-22 |
| 1275733644 | Branch Medical Clinic Gulfport | Clinic/Center | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2007-07-23 |
| Street Address |
5502 MARVIN SHIELDS BLVD |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598173841 | Valarie Anne Chapmon | Social Worker | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-07-31 |
| 1841630266 | Mari Elizabeth Lewis | Pediatrics | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2013-06-29 |
| 1275733644 | Branch Medical Clinic Gulfport | Clinic/Center | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2007-07-23 |
| 1043361785 | Pamela Ann Edwards | Nurse Practitioner | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| 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 |
|---|---|---|---|---|
| 1619381415 | Department of Air Force 81st Medical Group | Military/U.S. Coast Guard Pharmacy | 506 Larcher Blvd Ste B, Keesler Afb, MS 39534-2342 | 2014-06-19 |
| 1972917060 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 367 Fuller Rd Ste A-15, Meridian, MS 39309-5408 | 2014-06-17 |
| 1003915422 | 81st Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | Service Drive, Building 1704a, Keesler Afb, MS 39534 | 2006-09-22 |
| 1609975036 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 1001 Lee Avenue, Bldg 1302, Hattiesburg, MS 39401 | 2006-09-22 |
| 1477652899 | 81st Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 301 Fisher St # 104, Keesler Afb, MS 39534-2508 | 2006-09-22 |
| 1194824516 | Branch Medical Clinic Gulfport | Military/U.S. Coast Guard Pharmacy | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2006-09-22 |
| 1386743706 | 14th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 201 Independence Bldg 1100, Columbus, MS 39710-5300 | 2006-09-22 |
| 1558760504 | 14th Medical Squadron | Military/U.S. Coast Guard Pharmacy | 201 Independence Bldg 1100, Columbus, MS 39710-5300 | 2014-08-15 |
| 1710967526 | Keesler Medical Center 81mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 301 Fisher St, Ste 101 Rm 1a132, Keesler Afb, MS 39534-2508 | 2006-01-18 |
| 1487630356 | 14th Medical Group | Military/U.S. Coast Guard Pharmacy | 201 Independence, Suite 101, Columbus, MS 39710-5300 | 2005-12-21 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BRANCH MEDICAL CLINIC GULFPORT.
| 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.