1306945076 NPI number — EISENHOWER ARMY MEDICAL CENTER

Table of content: ASMIRIA FRANCO SULBARAN M.D. (NPI 1720433493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306945076 NPI number — EISENHOWER ARMY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EISENHOWER ARMY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306945076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W HOSPITAL RD
Provider Second Line Business Mailing Address:
ATTN MCHF-PAD
Provider Business Mailing Address City Name:
FORT GORDON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30905-5741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-787-6155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3RD AVENUE
Provider Second Line Business Practice Location Address:
BLDG 38200
Provider Business Practice Location Address City Name:
FT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-6155
Provider Business Practice Location Address Fax Number:
706-787-6175
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 332000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2020248 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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