Healthcare Provider Details

I. General information

NPI: 1366997108
Provider Name (Legal Business Name): AMC EISENHOWER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 NW 33RD ST ARMY HEALTH CLINIC SOUTHCOM
DORAL FL
33172-1202
US

IV. Provider business mailing address

EISENHOWER ARMY MEDICAL CENTER 300 W HOSPITAL RD ATTN: MCHF-PAD
FT GORDON GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 305-437-1749
  • Fax: 305-437-1149
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650