Healthcare Provider Details

I. General information

NPI: 1497270342
Provider Name (Legal Business Name): MADIGAN ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 9TH STREET
MARINA CA
93933
US

IV. Provider business mailing address

473 CABRILLO ST STE A1A
PRESIDIO OF MONTEREY CA
93944-3201
US

V. Phone/Fax

Practice location:
  • Phone: 866-957-2256
  • Fax:
Mailing address:
  • Phone: 866-957-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TRINA WILLIAMS
Title or Position: BUDGET ANALYST
Credential:
Phone: 831-242-7225