EISENHOWER ARMY MEDICAL CENTER (NPI# 1215036983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215036983 |
| Entity Type | Organization |
| Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Other Organization Name | GORDON CONNELLY PHCY |
| Practice Address |
Avenue B Bldg 29709 Mark Connelly Health Clinic Ft Gordon GA 30905 |
| Mailing Address |
Eisenhower Army Medical Center Attn Mchf-pad Ft Gordon GA 30905-5741 |
| Practice Telephone | 7067875167 |
| Practice Fax Number | 7067876175 |
| Mailing Telephone | 7067875167 |
| Mailing Fax Number | 7067876175 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2015-06-24 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2020249 | 01 |
| Other Name | Type Code |
|---|---|
| GORDON CONNELLY PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548672173 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Rodriguez Army Health Clinic (rahc), Bldg 21 Chrisman Rd., Fort Buchanan, PR 00934-3400 | 2014-06-02 |
| 1053661173 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Building 21, 21 Chrisman Rd, Ft Buchanan, PR 00934-3400 | 2012-09-17 |
| 1588868848 | Eisenhower Army Medical Center | Clinic/Center | 320 Hospital Road, Fort Gordon, GA 30905 | 2007-06-12 |
| 1396949657 | Eisenhower Army Medical Center | Clinic/Center | Building 25501, Brainard Avenue, Fort Gordon, GA 30905 | 2007-06-12 |
| 1619170198 | Eisenhower Army Medical Center | Clinic/Center | 1701 Hardee Avenue, S.w., Fort Mcpherson, GA 30330 | 2007-06-11 |
| 1750584363 | Eisenhower Army Medical Center | Clinic/Center | 1450 14th St, Hattiesburg, MS 39407-0001 | 2007-06-10 |
| 1104031194 | Eisenhower Army Medical Center | Clinic/Center | 1001 Hardy St, Hattiesburg, MS 39401-4165 | 2007-05-11 |
| 1346302494 | Eisenhower Army Medical Center | Military Hospital | 3395 Highland Park Pl, Memphis, TN 38111-4744 | 2006-12-15 |
| 1427131432 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 29709 B Street, Fort Gordon, GA 30905-5741 | 2006-10-23 |
| 1104925361 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Bldg 21, Ft Buchanan, PR 00934 | 2006-09-22 |
| Street Address |
AVENUE B BLDG 29709 MARK CONNELLY HEALTH CLINIC |
| City | FT GORDON |
| State | GA |
| Zip Code | 30905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417508995 | Priscilla Denise Brown | Prosthetic/Orthotic Supplier | 38200 3rd Ave, Fort Gordon, GA 30905 | 2019-09-25 |
| 1740754308 | Patricia Lynn Blevins | Nurse Practitioner | 300 E Hospital Dr, Augusta, GA 30905 | 2019-01-17 |
| 1861971335 | Isabella Anderson | Dentist | Usa Dental Activity, Hospital Dental Clinic, Bldg 38801 Academic, Ste B&c, Ft Gordon, GA 30905 | 2018-08-07 |
| 1972097426 | Cortney Wolfley | Student in an Organized Health Care Education/Training Program | Orthopaedics Ddeamc, 300 East Hospital Road, Fort Gordon, GA 30905 | 2018-06-19 |
| 1003337536 | David Jonathon Sabovich | Dentist | 38801 Academic Dr Ste B&cactivity, Suite B & C, Ft Gordon, GA 30905 | 2017-07-06 |
| 1437689411 | Marcos Aranda | Student in an Organized Health Care Education/Training Program | General Surgery, Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA 30905 | 2017-06-13 |
| 1659809846 | Brian Kevin Burke | Student in an Organized Health Care Education/Training Program | 300 East Hosptial Road, Fort Gordon, GA 30905 | 2017-06-01 |
| 1902334469 | Jacqueline Renee Mulhall | Student in an Organized Health Care Education/Training Program | Ddeamc, 300 E Hospital Rd, General Surgery, Fort Gordon, GA 30905 | 2017-05-30 |
| 1750837456 | Amanda R Bailey | Internal Medicine | 300 E. Hospital Dr., Fort Gordon, GA 30905 | 2016-09-01 |
| 1689120016 | Thomas S Moffitt | Internal Medicine | Im, Dwight D Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA 30905 | 2016-08-26 |
| Find all providers in zip 30905 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497854160 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | East Hospital Rd, Bldg 300 Rm 2c22, Ft Gordon, GA 30905 | 2006-09-21 |
| 1306945076 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 3rd Avenue, Bldg 38200, Ft Gordon, GA 30905 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023378403 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1100 Brookstone Centre Pkwy Rm 128, Columbus, GA 31904-4577 | 2012-05-21 |
| 1477811149 | Winn - Third Party Insurance | Military/U.S. Coast Guard Pharmacy | Bldg 8435, 306 Vanguard Road, Ft Stewart, GA 31314 | 2012-05-01 |
| 1992009401 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 6998 Old Cusseta Rd Bldg 4202, Fort Benning, GA 31905-5431 | 2010-12-28 |
| 1427131432 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 29709 B Street, Fort Gordon, GA 30905-5741 | 2006-10-23 |
| 1790875029 | Winn-third Party Insurance | Military/U.S. Coast Guard Pharmacy | Hunter Af Bldg, Bldg 1450, Savannah, GA 31409 | 2006-10-16 |
| 1457450066 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Bldg 366, Ft Macpherson, GA 30330-5000 | 2006-09-21 |
| 1649379314 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Marne Rd Bldg 9200, Ft Benning, GA 31905 | 2006-09-21 |
| 1548369150 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Marne Rd Bldg 9230, Ft Benning, GA 31905 | 2006-09-21 |
| 1467559211 | Winn-third Party Insurance | Military/U.S. Coast Guard Pharmacy | 1061 Harmon Ave Ste 2j11b, Fort Stewart, GA 31314-5641 | 2006-09-20 |
| 1376640128 | Kings Bay Pharmacy | Military/U.S. Coast Guard Pharmacy | 881 Uss James Madison Rd Bldg 1028, Navsubase, Kings Bay, GA 31547-2531 | 2006-09-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.