EISENHOWER ARMY MEDICAL CENTER (NPI# 1346443017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346443017 |
| Entity Type | Organization |
| Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Other Organization Name | USADC FT. GORDON ORAL HLTH CTR |
| Practice Address |
300 W Hospital Rd Usa Oral Health Center Fort Gordon GA 30905-5741 |
| Mailing Address |
300 W Hospital Rd Bldg W Attn Mchf-pad Fort Gordon GA 30905-5741 |
| Practice Telephone | 7067872601 |
| Mailing Telephone | 7067871125 |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2013-01-29 |
| Authorized Official Name | MARVIN PRIMOS (UBO MANAGER) |
| Authorized Official Telephone | 7067877204 |
| Is Organization Subpart | Y |
| Parent Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| USADC FT. GORDON ORAL HLTH CTR | 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 |
300 W HOSPITAL RD USA ORAL HEALTH CENTER |
| City | FORT GORDON |
| State | GA |
| Zip Code | 30905-5741 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922007467 | John Keenan Wilson | Internal Medicine | 300 W Hospital Rd, Building 300, Fort Gordon, GA 30905-5741 | 2005-07-18 |
| 1629687751 | Benjamin Lee Tigges | Nurse Anesthetist, Certified Registered | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2020-07-24 |
| 1104441179 | Gia-thien H Nguyen | Student in an Organized Health Care Education/Training Program | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2020-06-15 |
| 1184249765 | Roman Avila | Student in an Organized Health Care Education/Training Program | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2020-06-10 |
| 1417572116 | Francesco Anthony Biolzi | Student in an Organized Health Care Education/Training Program | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2020-06-09 |
| 1114568268 | Ryan Sever | Psychologist | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2019-09-30 |
| 1801446497 | Seth Randall | Nurse Practitioner | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2019-09-16 |
| 1275188179 | Jason Celestino | Nurse Anesthetist, Certified Registered | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2019-08-07 |
| 1467011668 | Angelina Kathleen Trush | Student in an Organized Health Care Education/Training Program | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2019-06-11 |
| 1790271989 | Joshua Orszag | Nurse Anesthetist, Certified Registered | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2018-07-10 |
| Find all providers in the same location | ||||
| 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 | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1295049773 | United States Army | Clinic/Center | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2010-07-27 |
| 1669687414 | Eisenhower Army Medical Center | Clinic/Center | 300 W Hospital Rd, Fort Gordon, GA 30905-5741 | 2007-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275929770 | Winn-thrid Party Insurance | Clinic/Center | 952 William H. Wilson Ave, Fort Stewart, GA 31314 | 2015-04-10 |
| 1528454022 | Winn-thrid Party Insurance | Clinic/Center | 1746 William H. Wilson Ave, Fort Stewart, GA 31314 | 2015-04-10 |
| 1235442328 | Winn-thrid Party Insurance | Clinic/Center | 2451a Hwy 17, Station Shopping Center, Richmond Hill, GA 31324-6422 | 2010-07-19 |
| 1053624130 | Martin Army Community Hospital | Clinic/Center | 6976 Old Cusseta Rd, Harmony Church, Fort Benning, GA 31905-5431 | 2010-07-19 |
| 1063616266 | Martin Army Community Hospital | Clinic/Center | 9200 Mame Road, Fort Benning, GA 31905 | 2007-06-12 |
| 1417151788 | Winn-thrid Party Insurance | Clinic/Center | 306 Vanguard Road, Building 2115, Suite 100, Fort Stewart, GA 31314 | 2007-06-12 |
| 1235333592 | Winn-thrid Party Insurance | Clinic/Center | 434 Vanguard Road, Fort Stewart, GA 31314 | 2007-06-12 |
| 1245434448 | Martin Army Community Hospital | Clinic/Center | 2622 Soldiers Plaza, Fort Benning, GA 31905 | 2007-06-12 |
| 1912101270 | Winn-thrid Party Insurance | Clinic/Center | 55 Pony Soldier Road, Building 253-s, Fort Stewart, GA 31314 | 2007-06-12 |
| 1083818280 | Martin Army Community Hospital | Clinic/Center | 2828 Sightseeing Road, Fort Benning, GA 31905 | 2007-06-12 |
| Find all providers with the same taxonomy | ||||
| City | FORT GORDON |
| Zip Code | 30905 |
Please comment or provide details below to improve the information on EISENHOWER ARMY MEDICAL CENTER.
| 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.