1386604387 NPI number — NAVAL HOSPITAL CAMP PENDLETON

Table of content: (NPI 1386604387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386604387 NPI number — NAVAL HOSPITAL CAMP PENDLETON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVAL HOSPITAL CAMP PENDLETON
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:
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:
1386604387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 555191
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMP PENDLETON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92055-5191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-725-1621
Provider Business Mailing Address Fax Number:
760-725-1661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MERCY CIRCLE
Provider Second Line Business Practice Location Address:
FIN MGMT CODE 0814
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-1621
Provider Business Practice Location Address Fax Number:
760-725-1661
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETERMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
BUSINESS OFFICE SUPERVISOR
Authorized Official Telephone Number:
760-725-1621

Provider Taxonomy Codes

  • Taxonomy code: 2865M2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HSP45020F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSM35020F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP35020F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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