MEDICARE: AMC EISENHOWER

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	333600000X	Pharmacy
2	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146408	OTHER		PK

General Provider Information

NPI Number	:	1225443948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMC EISENHOWER

Provider Business Mailing Address
First Line	:	EISENHOWER ARMY MEDICAL CENTER
Second Line	:	ATTN MCHF-PAD 300 W HOSPITAL RD
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-5741
Country	:	US
Telephone Number	:	706-787-0573
Fax Number	:	706-787-8034

Provider Business Practice Location Address
First Line	:	DWIGHT D. EISENHOWER ARMY MEDICAL CENTER
Second Line	:	BLDG 300, HOSPITAL ROAD
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-5950
Country	:	US
Telephone Number	:	706-829-3411
Fax Number	:	706-787-6120

Authorized Official
Title or Position	:	CHIEF DHA PASS
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-536-6650

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/11/2025

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Directions to “AMC EISENHOWER ” Practice Location

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