Provider Demographics
NPI:1578660742
Name:EISENHOWER ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:EISENHOWER ARMY MEDICAL CENTER
Other - Org Name:AMC EISENHOWER-GORDON
Other - Org Type:Other Name
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-787-8181
Mailing Address - Street 1:300 W HOSPITAL RD BLDG W
Mailing Address - Street 2:ATTN MCHF-PAD
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-1125
Mailing Address - Fax:
Practice Address - Street 1:300 W HOSPITAL RD BLDG W
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AN2598588OtherMEDCO
1497854160/1146643OtherPHARMACY NPI2/NCPDP
VAD000Medicare UPIN
AN2598588OtherMEDCO