Healthcare Provider Details

I. General information

NPI: 1306945076
Provider Name (Legal Business Name): EISENHOWER ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3RD AVENUE BLDG 38200
FT GORDON GA
30905
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 706-787-6155
  • Fax: 706-787-6175
Mailing address:
  • Phone: 706-787-6155
  • 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

VIII. Authorized Official

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