Provider Demographics
NPI:1124198809
Name:BROOKS CITY BASE CLINIC
Entity Type:Organization
Organization Name:BROOKS CITY BASE CLINIC
Other - Org Name:BROOKS HEALTH AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH AND WELLNESS CENTER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN-SWEARENGIN
Authorized Official - Last Name:POUNCEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:210-536-2976
Mailing Address - Street 1:2200 BERGQUIST DR
Mailing Address - Street 2:ATTN CREDENTIALS (CMC) SUITE ONE
Mailing Address - City:LACKLAND A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9907
Mailing Address - Country:US
Mailing Address - Phone:210-536-2976
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR
Practice Address - Street 2:ATTN CREDENTIALS (CMC) SUITE ONE
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9907
Practice Address - Country:US
Practice Address - Phone:210-536-2976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital