Provider Demographics
NPI:1467667287
Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Other - Org Name:TMC MEDICAL EXAM STATION (SFMC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-742-8291
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:ATTN TREASURER'S OFFICE
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-2444
Mailing Address - Fax:
Practice Address - Street 1:RICKER ROAD BLDG 2496
Practice Address - Street 2:SFMC
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:915-742-6047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295838787OtherPARENT FACILITY WILLIAM BEAUMONT AMC NPI
1295838787OtherPARENT FACILITY WILLIAM BEAUMONT AMC NPI
VAD000Medicare UPIN