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	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2093365	OTHER		PK

General Provider Information

NPI Number	:	1811096969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM BEAUMONT ARMY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	WILLIAM BEAUMONT ARMY MEDICAL CTR C/O TREASURERS OFFICE
Second Line	:	5005 N PIEDRAS ST
City	:	EL PASO
State	:	TX
Zip	:	79920-5001
Country	:	US
Telephone Number	:	915-569-2170
Fax Number	:	915-569-1556

Provider Business Practice Location Address
First Line	:	BLDG 2496
Second Line	:
City	:	FT BLISS
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-569-2170
Fax Number	:	915-569-1556

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	11/08/2024

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