Provider Demographics
NPI:1366861577
Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY COMMANDER, CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-742-2427
Mailing Address - Street 1:6560 CONTESSA RDG
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8176
Mailing Address - Country:US
Mailing Address - Phone:915-449-3311
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4037286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital