Provider Type Icon

EISENHOWER ARMY MEDICAL CENTER NPI 1164636320


NPI Information

NPI: 1164636320
Provider Name: EISENHOWER ARMY MEDICAL CENTER

Doing Business As: SOUTHCOM CLINIC-FT. GORDON

Classification: Clinic/Center - 261QM1100X
Entity Type: Organization

Specialization: Military/U.S. Coast Guard Outpatient

Address:
3511 NW 91ST AVE
DORAL, FL
ZIP 33172
Phone: (305) 437-1970
Get Directions

EISENHOWER ARMY MEDICAL CENTER is a military/u.s. coast guard outpatient clinic center in Doral, FL. The provider is the Defense Health Program or U.S. Coast Guard funded fixed facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A fixed facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the fixed facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. EISENHOWER ARMY MEDICAL CENTER NPI is 1164636320. The provider is registered as an organization entity type.
The provider Is Doing Business As Southcom Clinic-ft. Gordon.

The provider's business location address is:

3511 NW 91ST AVE
DORAL, FL
ZIP 33172-216
Phone: (305) 437-1970

The provider's authorized official is Marvin Primos .
The authorized official title is Ubo Manager and has the following contact phone number (706) 787-7204.

The enumeration date for this NPI number is 5/9/2007 and was last updated on 1/5/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332000000XMilitary/U.S. Coast Guard PharmacyNo
2261QM1100XClinic/CenterMilitary/U.S. Coast Guard OutpatientYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1OTH000MEDICARE UPIN
2VAD000MEDICARE UPIN
31578660742OTHERPARENT MTF NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.