EISENHOWER ARMY MEDICAL CENTER (NPI# 1770798316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770798316 |
| Entity Type | Organization |
| Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Other Organization Name | RODRIGUEZ ARMY HEALTH CLINIC-FT. BUCHANAN |
| Practice Address |
21 Chrisman Rd Fort Buchanan PR 00934-4519 |
| Mailing Address |
300 W Hospital Rd Bldg W Attn Mchf-pad Fort Gordon GA 30905-5741 |
| Practice Telephone | 7067875811 |
| Mailing Telephone | 7067871125 |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2013-01-29 |
| 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 |
|---|---|
| RODRIGUEZ ARMY HEALTH CLINIC-FT. BUCHANAN | 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 |
21 CHRISMAN RD |
| City | FORT BUCHANAN |
| State | PR |
| Zip Code | 00934-4519 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285794677 | Gilberto Caballero | Family Medicine | 21 Chrisman Rd, Fort Buchanan, PR 00934-4519 | 2006-12-08 |
| 1528482379 | Noelia Baez | Registered Nurse | 21 Chrisman Rd, Fort Buchanan, PR 00934-4519 | 2014-02-14 |
| 1952722308 | Henry Rodriguez | Pharmacy Technician | 21 Chrisman Rd, Rodriguez Army Health Clinic, Fort Buchanan, PR 00934-4519 | 2014-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932641297 | Vision Solution LLC | Optometrist | Ft Buchanan Exchange Building 689, Ft Bucananan, Guaynabo, PR 00934 | 2016-11-17 |
| 1174805659 | Danny Boulous Jaghab | Dietitian, Registered | 822 Dona Juana St, Ft Buchanan, PUERTO RICO 00934 | 2011-09-12 |
| 1457417982 | Daniel Rodriguez | Registered Nurse | Rodriguez Army Health Clinic, Fort Buchanan, San Juan, PR 00934 | 2006-12-29 |
| 1104925361 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Bldg 21, Ft Buchanan, PR 00934 | 2006-09-22 |
| 1326081456 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | Ft. Buchanan Exchange, National Vision Optical, Building 6, Ft. Buchanan, PR 00934 | 2006-06-14 |
| 1477588267 | Heriberto Baezmartinez | Specialist | Chrisman Road, Fort Buchanan, PR 00934-0000 | 2006-07-11 |
| 1255412250 | Hector M Perez | Optometrist | Bldg 689, Fort Buchanan, PR 00934-0461 | 2006-10-17 |
| 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 |
| 1912068115 | Norma Iris Gonzalez | Psychologist | 218 Brooks St. Blgd. 21, Rodriguez Army Health Clinic, Fort Buchanan, PR 00934-3400 | 2006-12-12 |
| Find all providers in zip 00934 | ||||
| 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] |
| City | FORT BUCHANAN |
| Zip Code | 00934 |
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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.