BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO NPI 1003006628

Clinic/Center (Military/U.S. Coast Guard Outpatient) in San Diego, CA

NPI 1003006628 Organization Clinic/Center Military/U.S. Coast Guard Outpatient

About BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO

Branch Medical Clinic Naval Station San Diego is a provider established in San Diego, California specializing in clinic/center (military/u.s. coast guard outpatient) . The NPI number of Branch Medical Clinic Naval Station San Diego is 1003006628 and was assigned on July 2007. The practitioner's primary taxonomy code is 261QM1100X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The authorized official of this NPI record is Mr. William Michael Condon (Navy Medicine Ubo Program Manager)

NPI

1003006628

Provider NameBRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO
Provider Location Address2450 CRAVEN STEET SAN DIEGO, CA 92136
Provider Mailing Address2450 CRAVEN ST SAN DIEGO, CA 92136
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Enumeration Date07-30-2007
Last Update Date04-04-2019


Primary Taxonomy

Taxonomy Code261QM1100X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationMilitary/U.S. Coast Guard Outpatient
Taxonomy DescriptionThe 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.

Business Address

BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO
2450 CRAVEN STEET
SAN DIEGO, CA
ZIP 92136
Phone: (619) 556-6302
Fax: (619) 556-9419

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Mailing Address

BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO
2450 CRAVEN ST
SAN DIEGO, CA
ZIP 92136
Phone: (619) 556-6302
Fax: (619) 556-9419



Authorized Official

Authorized Official NameMR. WILLIAM MICHAEL CONDON
Authorized Official TitleNAVY MEDICINE UBO PROGRAM MANAGER
Authorized Official Phone(240) 401-3643

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
HSP63228FMEDICAID (05)CA

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.