Provider Demographics
NPI:1952716896
Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Other - Org Name:DOD WHITE SANDS MR EPHCY
Other - Org Type:Doing Business As
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:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Mailing Address - Street 2:C/O TREASURERS OFFICE 5005 N. PIEDRAS ST.
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:575-674-3564
Mailing Address - Fax:575-674-3620
Practice Address - Street 1:1363 ABERDEEN ROAD
Practice Address - Street 2:
Practice Address - City:WHITE SANDS MISSILE RANGE
Practice Address - State:NM
Practice Address - Zip Code:88002-5520
Practice Address - Country:US
Practice Address - Phone:575-674-3564
Practice Address - Fax:575-674-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146594OtherPK