1619365285 NPI number — BROOKE ARMY MEDICAL CENTER

Table of content: (NPI 1619365285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619365285 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:
1619365285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3551 ROGER BROOKE DR
Provider Second Line Business Mailing Address:
MCHE-COU-T DEPT 211
Provider Business Mailing Address City Name:
SAN ANTONIO
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:
210-916-8558
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10010 ROGERS RUN
Provider Second Line Business Practice Location Address:
SUITE 100
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:
210-916-4141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BALLARD
Authorized Official First Name:
CLENTON
Authorized Official Middle Name:
Authorized Official Title or Position:
UBO MANAGER
Authorized Official Telephone Number:
210-916-8561

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)

  • Identifier: 1538251764 . This is a "PARENT FACILITY NPI 2" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com