Southcom Clinic-Ft. Gordon
LBN: Eisenhower Army Medical Center
Southcom Clinic-Ft. Gordon is an health care organization with primary practice located at 3511 Nw 91St Ave , Doral FL 33172-1216. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient, Suppliers / Military/U.S. Coast Guard Pharmacy. Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient is the primary health care specialty.
Eisenhower Army Medical Center can be contacted via phone (305) 437-1970, or through Primos, Marvin via phone (706) 787-7204.
Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient | 261QM1100X | ||
| Suppliers / Military/U.S. Coast Guard Pharmacy | 332000000X |
Profile Details
| NPI number | 1164636320 |
|---|---|
| LBN Legal business name | Eisenhower Army Medical Center |
| DBA Doing business as | Southcom Clinic-Ft. Gordon |
| Authorized official | Primos, Marvin |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | May 9th, 2007 |
| Last updated | Jan 5th, 2015 - about 10 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164636320 | NPPES |
| Other | 1578660742 | PARENT MTF NPI |
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