WEED ARMY COMMUNITY HOSPITAL (NPI# 1780968321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780968321 |
| Entity Type | Organization |
| Organization Name | WEED ARMY COMMUNITY HOSPITAL |
| Other Organization Name | TMC-1-IRWIN |
| Practice Address |
Building 295 Avenue B Fort Irwin CA 92310 |
| Mailing Address |
4th Street Bldg 166 Rm 109 Fort Irwin CA 92310-5109 |
| Practice Telephone | 7603806628 |
| Mailing Telephone | 7603805213 |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2015-04-07 |
| Authorized Official Name | DERRECK SUMMERS (C, PAD) |
| Authorized Official Telephone | 7603803392 |
| Is Organization Subpart | Y |
| Parent Organization Name | WEED ARMY COMMUNITY HOSPITAL |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PARENT FACILITY WEED ARMY COMMUNITY HOSPITAL NPI | 1275618514 | 01 |
| Other Name | Type Code |
|---|---|
| TMC-1-IRWIN | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083028989 | Weed Army Community Hospital | Clinic/Center | Bldg 189 Ave B, Fort Irwin, CA 92310 | 2014-06-18 |
| 1891109799 | Weed Army Community Hospital | Clinic/Center | Ave B Bldg R190, Warrior Care Center, Fort Irwin, CA 92310 | 2014-06-18 |
| 1467864090 | Weed Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 301 C St Bldg 990, Us Army Health Clinic,yuma Proving Ground, Ypg, AZ 85365-9498 | 2014-06-02 |
| 1689870859 | Weed Army Community Hospital | Clinic/Center | 3rd St and G St, Bldg 478, Fort Irwin, CA 92310 | 2007-06-25 |
| 1235335407 | Weed Army Community Hospital | Clinic/Center | 4th St and Interloop, Bldg 171, Fort Irwin, CA 92310 | 2007-06-25 |
| 1194931683 | Weed Army Community Hospital | Clinic/Center | Inner Loop Bldg 170, Fort Irwin, CA 92310 | 2007-05-14 |
| 1154465748 | Weed Army Community Hospital | Skilled Nursing Facility | Building 166 Third Street, Fort Irwin, CA 92310 | 2007-02-16 |
| 1306919501 | Weed Army Community Hospital | Military Hospital | Inner Loop, Fort Irwin, CA 92310-5109 | 2006-11-16 |
| 1396844338 | Weed Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 990, Yuma, AZ 85365 | 2006-09-22 |
| 1164521118 | Weed Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 170 Rm 207, Ft Irwin, CA 92310 | 2006-09-22 |
| Street Address |
BUILDING 295 AVENUE B |
| City | FORT IRWIN |
| State | CA |
| Zip Code | 92310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972100568 | Kellyann Michelle Francis | Dental Hygienist | 171, 4th St., Fort Irwin, CA 92310 | 2020-10-06 |
| 1598362253 | Lauren Elisabeth O'keefe | Dental Hygienist | 172 4th Street, Fort Irwin, CA 92310 | 2020-10-06 |
| 1215583737 | Lyra Angelica Velayo Matin | Marriage & Family Therapist | Bldg 390 N Loop Road, Fort Irwin, CA 92310 | 2019-08-12 |
| 1003384629 | Gary Barrow | Chiropractor | 390 Outerloop Rd, Fort Irwin, CA 92310 | 2018-11-13 |
| 1801373055 | Lee John Bizon Jr. | Nurse Practitioner | 390 North Loop Rd, Fort Irwin, CA 92310 | 2018-07-20 |
| 1619489937 | Ronda Marie Shiro | Dental Assistant | 171 Inner Loop Rpad, Fort Irwin, CA 92310 | 2017-10-26 |
| 1841713195 | James Degroot | Registered Nurse | Weed Army Community Hospital 390 North Loop Rd., Fort Irwin, CA 92310 | 2017-07-19 |
| 1356897615 | Alan Josiah Mills II | Dental Assistant | Bldg 171, 4th & Inner Loop Road, Fort Irwin, CA 92310 | 2016-08-28 |
| 1568917136 | Kathryn Paine | Physical Therapist | Building 390, North Loop Rd, Fort Irwin, CA 92310 | 2016-08-23 |
| 1487003588 | Kristyn Lauren Ollison | Dental Assistant | Bldg 248 A Meddac, Fort Irwin, CA 92310 | 2016-06-09 |
| Find all providers in zip 92310 | ||||
| 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 |
|---|---|---|---|---|
| 1083028989 | Weed Army Community Hospital | Clinic/Center | Bldg 189 Ave B, Fort Irwin, CA 92310 | 2014-06-18 |
| 1891109799 | Weed Army Community Hospital | Clinic/Center | Ave B Bldg R190, Warrior Care Center, Fort Irwin, CA 92310 | 2014-06-18 |
| 1689870859 | Weed Army Community Hospital | Clinic/Center | 3rd St and G St, Bldg 478, Fort Irwin, CA 92310 | 2007-06-25 |
| 1235335407 | Weed Army Community Hospital | Clinic/Center | 4th St and Interloop, Bldg 171, Fort Irwin, CA 92310 | 2007-06-25 |
| 1194931683 | Weed Army Community Hospital | Clinic/Center | Inner Loop Bldg 170, Fort Irwin, CA 92310 | 2007-05-14 |
| 1275618514 | Weed Army Community Hospital | Clinic/Center | Bldg 166, Fort Irwin, CA 92310-5109 | 2006-10-26 |
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| 1245624907 | Branch Medical Clinic Area 43 | Clinic/Center | 43 Area Branch Medical Clinic, Bldg 434057, Camp Pendleton, CA 92055 | 2015-03-20 |
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| 1871832394 | Branch Medical Clinic Area 62 | Clinic/Center | Bldg 620306 8th Street, Camp Pendleton, CA 92055 | 2013-02-04 |
| 1538393327 | United States Coast Guard | Clinic/Center | Isc Alameda, Coast Guard Island, Bldg 1, Alameda, CA 94501 | 2009-05-07 |
| 1003006628 | Branch Medical Clinic Naval Station San Diego | Clinic/Center | 2450 Craven Steet, San Diego, CA 92136-5599 | 2007-07-30 |
| Find all providers with the same taxonomy | ||||
| City | FORT IRWIN |
| Zip Code | 92310 |
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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.