1457742785 NPI number — BROOKE ARMY MEDICAL CENTER

Table of content: (NPI 1457742785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457742785 NPI number — BROOKE ARMY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKE 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:
1457742785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BROOKE ARMY MEDICAL CENTER
Provider Second Line Business Mailing Address:
3551 ROGER BROOKE DR MCHE-ZAR-UT 201
Provider Business Mailing Address City Name:
FORT SAM HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78234-4513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-916-8563
Provider Business Mailing Address Fax Number:
210-916-4851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10010 ROGERS RUN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-916-2872
Provider Business Practice Location Address Fax Number:
210-916-2124
Provider Enumeration Date:
02/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ALPIZAR
Authorized Official First Name:
NORA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF, UNIFORM BUSINESS OFFICE
Authorized Official Telephone Number:
210-916-8563

Provider Taxonomy Codes

  • Taxonomy code: 286500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2150116 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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