Provider Demographics
NPI:1508069527
Name:NAVAL HOSPITAL CAMP PENDLETON
Entity Type:Organization
Organization Name:NAVAL HOSPITAL CAMP PENDLETON
Other - Org Name:BMC YUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-725-1621
Mailing Address - Street 1:PO BOX 555191
Mailing Address - Street 2:FIN MGMT CODE 0814
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5191
Mailing Address - Country:US
Mailing Address - Phone:760-725-1621
Mailing Address - Fax:760-725-1661
Practice Address - Street 1:BLDG 1175
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85369
Practice Address - Country:US
Practice Address - Phone:760-725-1621
Practice Address - Fax:760-725-1661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL CAMP PENDLETON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2014-04-10
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
CA1386604387OtherPARENT FACILITY NPI