Healthcare Provider Details

I. General information

NPI: 1669687489
Provider Name (Legal Business Name): WILLIAM BEAUMONT ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SSG SIMS STREET BLDG 11335 MENDOZA SOLDIER FAMILY CARE CLINIC
EL PASO TX
79920
US

IV. Provider business mailing address

5005 N PIEDRAS ST ATTN TREASURER'S OFFICE
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-1107
  • Fax:
Mailing address:
  • Phone: 915-569-2444
  • 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: JOSE CRUZ-MELENDEZ
Title or Position: UBO MANAGER
Credential:
Phone: 915-742-8291