BRANCH HEALTH CLINIC SOUDA BAY (NPI# 1902091044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902091044 |
| Entity Type | Organization |
| Organization Name | BRANCH HEALTH CLINIC SOUDA BAY |
| Practice Address |
Psc 814 Box 19 Fpo AE 09865 |
| Mailing Address |
Psc 836 Box 2670 Fpo AE 09636-9998 |
| Practice Telephone | 0113909556 |
| Practice Fax Number | 01139095563898 |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2017-10-25 |
| Authorized Official Name | WILLIAM M CONDON (BUMED UBO) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL HOSPITAL SIGONELLA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Street Address |
PSC 814 BOX 19 |
| City | FPO |
| State | AE |
| Zip Code | 09865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083775613 | Brent A Bushnell | Military Health Care Provider | Psc 814 Box 19, Fpo, AE 09865 | 2006-12-13 |
| 1659575512 | Jeffrey C George | Military Health Care Provider | Psc 814 Box 19, Fpo, AP 09865 | 2007-06-13 |
| 1558565929 | Kenneth Roy Mazer | Military Health Care Provider | Psc 814 Box 19, Fpo, AE 09865 | 2007-06-12 |
| 1174727549 | Natalie Soto | Military Health Care Provider | Psc 814 Box 19, Fpo, AE 09865 | 2007-06-12 |
| 1104995331 | Naval Hospital Sigonella | Military/U.S. Coast Guard Pharmacy | Chania Crete Greece, Psc 814, Fpo, AE 09865-0019 | 2006-11-06 |
| 1295988483 | Kati Lynn Ivey | Military Health Care Provider | Psc 814 Box 19, Fpo, AE 09865-0019 | 2008-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841899853 | London Mingo | Social Worker | 2769 Yaka Kin Cho, Fpo, AP 96388-0071 | 2020-10-21 |
| 1538768833 | James Blake Weldon | Military Health Care Provider | Unit 100517 Bx 1, Fpo, AP 09655 | 2020-10-19 |
| 1487260311 | Doria Living | Registered Nurse | Ushno, Fpo, AP 96367 | 2020-09-16 |
| 1225643307 | Brice Blahnik | Dentist | 1 St Dental Battalion/naval Dental Center Attn: Medical, Bldg 2238 A Ave Camp Pendleton, Ca. 92055-5221, Fpo, AA 92055-5221 | 2020-09-15 |
| 1609489061 | Genesis Health Care Inc | Home Health | Uss Wasp Lhd1 Unit 100261, Fpo, AE 09514 | 2020-08-26 |
| 1669081857 | Acacia L Elmer | Registered Nurse | Psc 808 Box 3104, Fpo, AE 09618-0032 | 2020-07-24 |
| 1932724754 | William Dowling | Student in an Organized Health Care Education/Training Program | 260 John Paul Jones Circle, Fpo, AA 23708 | 2020-06-09 |
| 1518581776 | Taylor D Benson | Audiologist | Building 960, Floor 3, East Wing, Fpo, AP 96362-0017 | 2020-06-03 |
| 1740803279 | Issa Khalil | Military Health Care Provider | Uss Donald Cook, Fpo, AE 09566 | 2020-05-19 |
| 1295360055 | Kiran Kumar Gurung | Dental Hygienist | Uss Bataan (lhd-5), Fpo, AE 09554-1657 | 2020-03-11 |
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| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811182959 | Branch Medical Clinic Bahrain | Clinic/Center | Psc 851, Box 340, Fpo, AE 09834-0004 | 2007-09-12 |
| 1841483559 | Branch Medical Clinic Chinhae | Clinic/Center | Psc 479, Fpo, AP 96269 | 2007-08-26 |
| 1023201886 | Branch Medical Clinic Sasebo | Clinic/Center | Psc 475 Box 1 Code 081c, Fpo, AP 96351 | 2007-08-23 |
| 1447429667 | Branch Medical Clinic Camp Fuji | Clinic/Center | Psc 475 Box 1 Code 081c, Fpo, AP 96351 | 2008-02-21 |
| 1194911511 | Branch Medical Clinic Capodichino | Clinic/Center | Psc 808 Box 19, Fpo, AE 09618-0001 | 2007-09-19 |
| 1578756284 | Branch Medical Clinic Diego Garcia | Clinic/Center | Psc 466 Box 3, Fpo, AP 96595 | 2007-08-26 |
| 1376734624 | Branch Medical Clinic Sasebo Comfleact | Clinic/Center | Psc 476 Box 25, Fpo, AP 96322 | 2007-08-01 |
| 1639360985 | Branch Medical Clinic Atsugi | Clinic/Center | Psc 477 Box 2, Fpo, AP 96303 | 2007-08-01 |
| 1528268844 | Branch Medical Clinic Camp Bush | Clinic/Center | Psc 482, Uniform Business Office, Fpo, AP 96362 | 2007-07-24 |
| 1982804209 | Branch Medical Clinic Camp Hansen | Clinic/Center | Psc 482, Uniform Business Office, Fpo, AP 96362 | 2007-07-24 |
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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.