Provider Demographics
NPI:1699726570
Name:NAVAL HOSPITAL TWENTYNINE PALMS
Entity type:Organization
Organization Name:NAVAL HOSPITAL TWENTYNINE PALMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-830-2121
Mailing Address - Street 1:1145 STURGIS ROAD
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278
Mailing Address - Country:US
Mailing Address - Phone:760-830-2121
Mailing Address - Fax:760-830-2714
Practice Address - Street 1:1145 STURGIS ROAD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278
Practice Address - Country:US
Practice Address - Phone:760-830-2121
Practice Address - Fax:760-830-2714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL TWENTYNINE PALMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP33257FOtherMEDI-CAL INPATIENT
CA5662OtherBLUE CROSS & BLUE SHIELD
CAHSP43257FOtherMEDI-CAL OUTPATIENT
CA05-129FMedicare ID - Type UnspecifiedCIVILIAN HUMANITARIAN