Provider Demographics
NPI:1225443948
Name:EISENHOWER ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:EISENHOWER ARMY MEDICAL CENTER
Other - Org Name:DOD FT EISENHOWER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:EISENHOWER ARMY MEDICAL CENTER
Mailing Address - Street 2:ATTN MCHF-PAD 300 W HOSPITAL RD
Mailing Address - City:FORT EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-0573
Mailing Address - Fax:706-787-8034
Practice Address - Street 1:DWIGHT D. EISENHOWER ARMY MEDICAL CENTER
Practice Address - Street 2:BLDG 300, HOSPITAL ROAD
Practice Address - City:FORT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-5950
Practice Address - Country:US
Practice Address - Phone:706-787-0115
Practice Address - Fax:706-787-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146408OtherPK