Provider Demographics
NPI:1962695775
Name:EISENHOWER ARMY MED CEN
Entity type:Organization
Organization Name:EISENHOWER ARMY MED CEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-787-8181
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:ATTN UBO
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-7204
Mailing Address - Fax:
Practice Address - Street 1:300 W HOSPITAL RD BLDG W
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
OTH000Medicare UPIN