BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO Full NPI Record 1003006628

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

Complete NPI Dataset

The following table represents the complete NPI 1003006628 dataset for Branch Medical Clinic Naval Station San Diego in 2450 CRAVEN STEET SAN DIEGO, CA 92136. The data table includes a list of all field names, values and definitions of the complete NPI record. The NPI dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1003006628The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. 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 (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameBRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGOThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address2450 CRAVEN STThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameSAN DIEGOThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameCAThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code921365599The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number6195566302The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number6195569419The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address2450 CRAVEN STEETThe first line 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 Business Practice Location Address City NameSAN DIEGOThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCAThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code921365599The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number6195566302The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6195569419The fax number associated with the location address of the provider being identified.
Provider Enumeration Date7/30/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date4/4/2019The date that a record was last updated or changed.
Authorized Official Last NameCONDONThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameWILLIAMThe first name of the authorized official.
Authorized Official Middle NameMICHAELThe middle name of the authorized official.
Authorized Official Title or PositionNAVY MEDICINE UBO PROGRAM MANAGERThe title or position of the authorized official.
Authorized Official Telephone Number2404013643The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QM1100XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 1HSP63228FAdditional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1CA
Is Organization SubpartY
Parent Organization LBNNAVAL MEDICAL CENTER SAN DIEGO
Parent Organization TINUNAVAIL
Authorized Official Name Prefix TextMR.