Provider Demographics
NPI:1366677445
Name:NAVAL MEDICAL CENTER SAN DIEGO
Entity Type:Organization
Organization Name:NAVAL MEDICAL CENTER SAN DIEGO
Other - Org Name:US NAVY
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-524-0113
Mailing Address - Street 1:2051 CUSHING RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6173
Mailing Address - Country:US
Mailing Address - Phone:619-524-0113
Mailing Address - Fax:
Practice Address - Street 1:2051 CUSHING RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6173
Practice Address - Country:US
Practice Address - Phone:619-524-0113
Practice Address - Fax:619-524-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital