Provider Demographics
NPI:1093814147
Name:BROOKE ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:BROOKE ARMY MEDICAL CENTER
Other - Org Name:FT SAM UCC PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, UNIFORM BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-916-8563
Mailing Address - Street 1:BROOKE ARMY MECICAL CENTER
Mailing Address - Street 2:3551 ROGER BROOKE DR MCHE-ZAR-UT 201
Mailing Address - City:SNA ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-5101
Practice Address - Fax:210-916-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093305OtherPK
005518OtherNCPDP PAYMENT CENTER