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
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1548693526
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	:	5410 MAC WILLIAMS RD
Second Line	:	BLDG 5026 CAMP BULLIS
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257
Country	:	US
Telephone Number	:	210-916-4141
Fax Number	:

Authorized Official
Title or Position	:	UBO
Name	:	CHARON MONIQUE SEYMORE
Credential	:
Telephone Number	:	210-916-8563

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	06/30/2025

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