1497270342 NPI number — MADIGAN ARMY MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497270342 NPI number — MADIGAN ARMY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADIGAN 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:
1497270342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
473 CABRILLO ST STE A1A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESIDIO OF MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93944-3201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-957-2256
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 9TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-957-2256
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUDGET ANALYST
Authorized Official Telephone Number:
831-242-7225

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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