Southcom Clinic-Ft. Gordon

LBN: Eisenhower Army Medical Center
Southcom Clinic-Ft. Gordon is an health care organization with primary practice located at 3511 Nw 91St Ave , Doral FL 33172-1216. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient, Suppliers / Military/U.S. Coast Guard Pharmacy. Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient is the primary health care specialty. Eisenhower Army Medical Center can be contacted via phone (305) 437-1970, or through Primos, Marvin via phone (706) 787-7204.

Contact Information

Primary practice address
3511 Nw 91St Ave Doral FL 33172-1216
Phone: (305) 437-1970
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Primos, Marvin
Phone: (706) 787-7204

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient 261QM1100X
Suppliers / Military/U.S. Coast Guard Pharmacy 332000000X

Profile Details

NPI number 1164636320
LBN Legal business name Eisenhower Army Medical Center
DBA Doing business as Southcom Clinic-Ft. Gordon
Authorized official Primos, Marvin
Entity Organization
Organization subpart 1 Yes
Enumeration date May 9th, 2007
Last updated Jan 5th, 2015 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164636320 NPPES
Other 1578660742 PARENT MTF NPI

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