EISENHOWER ARMY MEDICAL CENTER (NPI# 1750584363) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750584363 |
| Entity Type | Organization |
| Organization Name | EISENHOWER ARMY MEDICAL CENTER |
| Other Organization Name | USADC CAMP SHELBY 6 |
| Practice Address |
1450 14th St Hattiesburg MS 39407-0001 |
| Mailing Address |
300 W Hospital Rd Bldg W Attn Mchf-pad Fort Gordon GA 30905-5741 |
| Practice Telephone | 6015582575 |
| Mailing Telephone | 7067871125 |
| Enumeration Date | 2007-06-10 |
| 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 CAMP SHELBY 6 | 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 |
| 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 |
| 1609975036 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 1001 Lee Avenue, Bldg 1302, Hattiesburg, MS 39401 | 2006-09-22 |
| Street Address |
1450 14TH ST |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39407-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659597235 | Jon Edward Schiff | Dentist | Camp Shelby Dental Clinic, Bldg 1450, 14th Street, Camp Shelby, MS 39407 | 2007-04-18 |
| 1861522989 | Terri Pinson | Social Worker | 1442 16th Street, Medical Task Force Shelby, Camp Shelby, MS 39407 | 2007-03-07 |
| 1497892483 | Allen Sean Dalafave | Social Worker | 1302 Lee Ave, Hattiesburg, MS 39407-0001 | 2007-01-31 |
| 1619047412 | Deborah Rose Hunter | Internal Medicine | Camp Shelby, Troop Medical Clinic Bldg 1302, Camp Shelby, MS 39407-5500 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548867088 | Julia Hovatter | Occupational Therapist | 4700 Hardy St Ste J1, Hattiesburg, MS 39402-1300 | 2020-10-07 |
| 1356948277 | Tiffany Nicole Dear | Counselor | 28 Dobby Ln, Hattiesburg, MS 39402-7044 | 2020-10-04 |
| 1952918278 | Lincoln Dental Arts, Pllc | Dentist | 4301 Lincoln Rd # 20, Hattiesburg, MS 39402-3036 | 2020-09-30 |
| 1962019745 | Jennifer Baker Sheridan | Social Worker | 615 W Pine St, Hattiesburg, MS 39401-3835 | 2020-09-25 |
| 1942817895 | Thaxton Sullivan | Specialist/Technologist | 3 Courtland Dr Apt 50, Hattiesburg, MS 39402-8186 | 2020-09-24 |
| 1710593470 | Britney Mangum Huber | Marriage & Family Therapist | 607 Corinne St Ste A2, Hattiesburg, MS 39401-3827 | 2020-09-18 |
| 1518572965 | Resilient Therapy and Solutions, Pllc | Clinic/Center | 5266 Old Hwy 11 Ste 50, #308, Hattiesburg, MS 39402 | 2020-09-12 |
| 1003420092 | Merrick Greene Jackson | Student in an Organized Health Care Education/Training Program | 120 Natalie Ln, Hattiesburg, MS 39402-3080 | 2020-09-07 |
| 1588278618 | Joshua Cole Hammons | Nurse Practitioner | 2134 Weeping Willow Cir, Hattiesburg, MS 39402-6096 | 2020-09-05 |
| 1518571900 | Lawanda Nicole Ellis | Nurse Practitioner | 4124 W 4th St Apt 2010, Hattiesburg, MS 39401-5791 | 2020-09-02 |
| Find all providers in HATTIESBURG | ||||
| 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 |
|---|---|---|---|---|
| 1104031194 | Eisenhower Army Medical Center | Clinic/Center | 1001 Hardy St, Hattiesburg, MS 39401-4165 | 2007-05-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609076033 | Branch Medical Clinic Meridian | Clinic/Center | 1801 Fuller Rd, Meridian, MS 39309-5106 | 2007-07-24 |
| 1275733644 | Branch Medical Clinic Gulfport | Clinic/Center | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2007-07-23 |
| City | HATTIESBURG |
| Zip Code | 39407 |
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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.