Provider Demographics
NPI:1770997124
Name:MADIGAN ARMY MEDICAL CTR
Entity type:Organization
Organization Name:MADIGAN ARMY MEDICAL CTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:CO ATTN MCHJ-PD-MSA 9040A FITZSIMMONS DR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:831-242-5382
Mailing Address - Fax:831-242-5809
Practice Address - Street 1:473 CABRILLO ST BLDG 422
Practice Address - Street 2:U.S. ARMY HEALTH CLINIC PRESIDIO OF MONTEREY
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3201
Practice Address - Country:US
Practice Address - Phone:831-242-5382
Practice Address - Fax:831-242-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146220OtherPK