Provider Demographics
NPI:1982183737
Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Other - Org Name:DESERT SAGE MEDICAL HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL SERVICES ACCOUNTS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATIVIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-742-2753
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:ATTN TREASUER'S OFFICE
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-6199
Mailing Address - Fax:
Practice Address - Street 1:7400 HELEN OF TROY
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-742-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-13
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295838787OtherPARENT FACILITY WILLIAM BEAUMONT ARMY MEDICAL CENTER NPI