Provider Demographics
NPI:1497270342
Name:MADIGAN ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:MADIGAN ARMY MEDICAL CENTER
Other - Org Name:GOURLEY VA DOD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUDGET ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-242-7225
Mailing Address - Street 1:473 CABRILLO ST STE A1A
Mailing Address - Street 2:
Mailing Address - City:PRESIDIO OF MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-3201
Mailing Address - Country:US
Mailing Address - Phone:866-957-2256
Mailing Address - Fax:
Practice Address - Street 1:201 9TH STREET
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933
Practice Address - Country:US
Practice Address - Phone:866-957-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADIGAN ARMY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient