Healthcare Provider Details

I. General information

NPI: 1962695775
Provider Name (Legal Business Name): EISENHOWER ARMY MED CEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD BLDG W
FORT GORDON GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL RD ATTN UBO
FORT GORDON GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-5811
  • Fax:
Mailing address:
  • Phone: 706-787-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: AMBROSE STURGIS
Title or Position: UBO MANAGER
Credential:
Phone: 706-787-8181