Healthcare Provider Details

I. General information

NPI: 1255537510
Provider Name (Legal Business Name): MADIGAN ARMY MEDICAL CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 CABRILLO ST BLDG 422
MONTEREY CA
93944-3201
US

IV. Provider business mailing address

9040A JACKSON AVE ATTN: MCHJ-CSA-U
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 831-242-5612
  • Fax:
Mailing address:
  • Phone: 253-968-6598
  • 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: KAREN MADY
Title or Position: TPC MANAGER
Credential:
Phone: 253-968-6598