Provider Demographics
NPI:1710084561
Name:NAVAL HOSPITAL PENSACOLA
Entity Type:Organization
Organization Name:NAVAL HOSPITAL PENSACOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NAVY MEDICINE UBO PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:NAVAL HOSPITAL PENSACOLA
Mailing Address - Street 2:6000 W HWY 98 CODE 41C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:504-678-1590
Mailing Address - Fax:504-678-1596
Practice Address - Street 1:4400 DAUPHINE ST BLDG 601
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70146-5609
Practice Address - Country:US
Practice Address - Phone:504-678-1590
Practice Address - Fax:504-678-1596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL PENSACOLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2034915OtherPK