1669687489 NPI number — WILLIAM BEAUMONT ARMY MEDICAL CENTER

Table of content: (NPI 1669687489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669687489 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:
1669687489
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:
SSG SIMS STREET BLDG 11335
Provider Second Line Business Practice Location Address:
MENDOZA SOLDIER FAMILY CARE CLINIC
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-742-1107
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

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)

  • Identifier: 1295838787 . This is a "PARENT FACILITY WILLIAM BEAUMONT AMC NPI" identifier . This identifiers is of the category "OTHER".




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