1639382047 NPI number — WILLIAM BEAUMONT 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 1639382047 NPI number — WILLIAM BEAUMONT ARMY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM BEAUMONT 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:
1639382047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5005 N PIEDRAS ST
Provider Second Line Business Mailing Address:
ATTN TREASURER'S OFFICE
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79920-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-569-2444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 ROCK ISLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SANDS MISSILE RANGE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88002-1197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-678-4992
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ-MELENDEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
UBO MANAGER
Authorized Official Telephone Number:
915-742-8291

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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