EISENHOWER ARMY MEDICAL CENTER (NPI# 1609975036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609975036 |
| Entity Type | Organization |
| Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Other Organization Name | CAMP SHELBY TMC PHCY |
| Practice Address |
1001 Lee Avenue Bldg 1302 Hattiesburg MS 39401 |
| Mailing Address |
Eisenhower Army Medical Center Attn Mchf-pad 300 W Hospital Rd Ft Gordon GA 30905-5741 |
| Practice Telephone | 6015582295 |
| Practice Fax Number | 6015582445 |
| Mailing Telephone | 6015582295 |
| Mailing Fax Number | 6015582445 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-06-18 |
| 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 | 2047112 | 01 |
| Other Name | Type Code |
|---|---|
| CAMP SHELBY TMC 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 |
1001 LEE AVENUE BLDG 1302 |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| 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 |
|---|---|---|---|---|
| 1619381415 | Department of Air Force 81st Medical Group | Military/U.S. Coast Guard Pharmacy | 506 Larcher Blvd Ste B, Keesler Afb, MS 39534-2342 | 2014-06-19 |
| 1972917060 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 367 Fuller Rd Ste A-15, Meridian, MS 39309-5408 | 2014-06-17 |
| 1003915422 | 81st Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | Service Drive, Building 1704a, Keesler Afb, MS 39534 | 2006-09-22 |
| 1477652899 | 81st Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 301 Fisher St # 104, Keesler Afb, MS 39534-2508 | 2006-09-22 |
| 1194824516 | Branch Medical Clinic Gulfport | Military/U.S. Coast Guard Pharmacy | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2006-09-22 |
| 1386743706 | 14th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 201 Independence Bldg 1100, Columbus, MS 39710-5300 | 2006-09-22 |
| 1558760504 | 14th Medical Squadron | Military/U.S. Coast Guard Pharmacy | 201 Independence Bldg 1100, Columbus, MS 39710-5300 | 2014-08-15 |
| 1558773192 | Branch Medical Clinic Gulfport | Military/U.S. Coast Guard Pharmacy | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-06-02 |
| 1710967526 | Keesler Medical Center 81mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 301 Fisher St, Ste 101 Rm 1a132, Keesler Afb, MS 39534-2508 | 2006-01-18 |
| 1487630356 | 14th Medical Group | Military/U.S. Coast Guard Pharmacy | 201 Independence, Suite 101, Columbus, MS 39710-5300 | 2005-12-21 |
| Find all providers with the same taxonomy | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
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.