Provider Demographics
NPI:1629038997
Name:BRANCH MEDICAL CLINIC PARRIS ISLAND
Entity Type:Organization
Organization Name:BRANCH MEDICAL CLINIC PARRIS ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUMED UBO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:PO BOX 19501
Mailing Address - Street 2:
Mailing Address - City:PARRIS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29905-9501
Mailing Address - Country:US
Mailing Address - Phone:843-228-5384
Mailing Address - Fax:
Practice Address - Street 1:BLDG 598
Practice Address - Street 2:
Practice Address - City:PARRIS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29905
Practice Address - Country:US
Practice Address - Phone:843-228-5384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL BEAUFORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-23
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient