Provider Demographics
NPI:1578662250
Name:EISENHOWER ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:EISENHOWER ARMY MEDICAL CENTER
Other - Org Name:MACPHERSON MAIN PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR PHRMCY OPERATIONS CNTR
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:210-221-8274
Mailing Address - Street 1:300 W HOSPITAL RD
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 1:1701 HARDEE AVE SW
Practice Address - Street 2:BLDG 125
Practice Address - City:FT MCPHERSON
Practice Address - State:GA
Practice Address - Zip Code:30330
Practice Address - Country:US
Practice Address - Phone:404-464-0306
Practice Address - Fax:404-464-0303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EISENHOWER ARMY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1147102OtherOTHER ID NUMBER-COMMERCIAL NUMBER