Healthcare Provider Details

I. General information

NPI: 1194031583
Provider Name (Legal Business Name): BAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR. BAMC-MCHEQD (CREDS)
FORT SAM HOUSTON TX
78218-6200
US

IV. Provider business mailing address

3851 ROGER BROOKE DR. BAMC-MCHEQD (CREDS)
FORT SAM HOUSTON TX
78218-6200
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-2460
  • Fax:
Mailing address:
  • Phone: 210-916-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number390200000X
License Number StateTX

VIII. Authorized Official

Name: RAMONA MONTGOMERY
Title or Position: CHIEF, CREDENTIALS SERVICE
Credential:
Phone: 210-916-2460