Provider Demographics
NPI:1851773535
Name:WBAMC DEPT OF MEDICINE/IM TRAINING PROGRAM
Entity Type:Organization
Organization Name:WBAMC DEPT OF MEDICINE/IM TRAINING PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR FOR GME OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-742-2521
Mailing Address - Street 1:5005 N PIEDRAS STREET,
Mailing Address - Street 2:ATTN: DOM/IM PROGRAM WBAMC
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-2180
Mailing Address - Fax:915-742-3238
Practice Address - Street 1:5005 N. PIEDRAS STREET,
Practice Address - Street 2:ATTN: DOM/IM PROGRAM WBAMC
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-2180
Practice Address - Fax:915-742-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital