MEDICARE: WILLIAM BEAUMONT 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	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1295838787	OTHER		PARENT FACILITY WILLIAM BEAUMONT AMC NPI

General Provider Information

NPI Number	:	1467667287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM BEAUMONT ARMY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	5005 N PIEDRAS ST
Second Line	:	ATTN TREASURER'S OFFICE
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-569-2444
Fax Number	:

Provider Business Practice Location Address
First Line	:	RICKER ROAD BLDG 2496
Second Line	:	SFMC
City	:	FORT BLISS
State	:	TX
Zip	:	79920
Country	:	US
Telephone Number	:	915-742-6047
Fax Number	:

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	JOSE CRUZ-MELENDEZ
Credential	:
Telephone Number	:	915-742-8291

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	11/08/2024

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