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NPI Code Detail

MEDICARE: AMC BAMC-FSH

MEDICARE: AMC BAMC-FSH
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
1261QM1100XMilitary/U.S. Coast Guard Outpatient Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11538251764OTHERPARENT NPI

General Provider Information

NPI Number : 1396119681
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMC BAMC-FSH
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line : MCHE-COU-T DEPT 201
City : SAN ANTONIO
State : TX
Zip : 78234-4513
Country : US
Telephone Number : 210-916-8558
Fax Number :
Provider Business Practice Location Address
First Line : 2407 N NEW BRAUNFELS
Second Line : BLDG 147
City : FT SAM HOUSTON
State : TX
Zip : 78234
Country : US
Telephone Number : 210-916-0475
Fax Number :
Authorized Official
Title or Position : UBO
Name : CHARON MONIQUE SEYMORE
Credential :
Telephone Number : 210-916-8563
Provider Enumeration Date : 11/24/2015
Last Update Date : 06/30/2025

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