Provider Demographics
NPI:1558773192
Name:BRANCH MEDICAL CLINIC GULFPORT
Entity Type:Organization
Organization Name:BRANCH MEDICAL CLINIC GULFPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA POSC
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:NAVAL HOSPITAL PENSACOLA 6000 W
Mailing Address - Street 2:HWY 98 CODE 11
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0003
Mailing Address - Country:US
Mailing Address - Phone:228-822-5784
Mailing Address - Fax:228-871-2135
Practice Address - Street 1:5502 MARVIN SHIELDS BLVD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-822-5783
Practice Address - Fax:228-871-3648
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL PENSACOLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-02
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146016OtherPK