Connelly Health Clinic
LBN: Eisenhower Army Medical Center
Connelly Health Clinic is an health care organization with primary practice located at 29709 B Street , Fort Gordon GA 30905-5741. 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 (706) 787-5811, or through Primos, Marvin via phone (706) 787-7204.
Contact Information
Primary practice address
29709 B Street
Fort Gordon GA 30905-5741
Phone: (706) 787-5811
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient | 261QM1100X | ||
| Suppliers / Military/U.S. Coast Guard Pharmacy | 332000000X |
Profile Details
| NPI number | 1427131432 |
|---|---|
| LBN Legal business name | Eisenhower Army Medical Center |
| DBA Doing business as | Connelly Health Clinic |
| Authorized official | Primos, Marvin |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Oct 23rd, 2006 |
| Last updated | Jan 31st, 2013 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1427131432 | NPPES |
| Other | 1578660742 | PARENT MTF NPI |
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