Provider Demographics
NPI:1194031583
Name:BAMC
Entity Type:Organization
Organization Name:BAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, CREDENTIALS SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-916-2460
Mailing Address - Street 1:3851 ROGER BROOKE DR.
Mailing Address - Street 2:BAMC-MCHEQD (CREDS)
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78218-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-2460
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DR.
Practice Address - Street 2:BAMC-MCHEQD (CREDS)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78218-6200
Practice Address - Country:US
Practice Address - Phone:210-916-2460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX390200000XOtherBAMC