MEDICARE: EISENHOWER ARMY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4022935	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1104925361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EISENHOWER ARMY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	300 W HOSPITAL RD
Second Line	:	ATTN MCHF-PAD
City	:	FORT GORDON
State	:	GA
Zip	:	30905-5741
Country	:	US
Telephone Number	:	706-787-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 21
Second Line	:
City	:	FT BUCHANAN
State	:	PR
Zip	:	00934
Country	:	US
Telephone Number	:	787-740-2052
Fax Number	:

Authorized Official
Title or Position	:	MGR PHRMCY OPERATIONS CNTR
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-221-8274

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	05/28/2024

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