SOUTHCOM CLINIC-FT. GORDON
NPI 1164636320
Clinic/Center - Military/U.S. Coast Guard Outpatient in Doral, FL

Active since May 09, 2007
3511 NW 91ST AVE, DORAL, FL 33172(305) 437-1970 Get Directions Write a Review

NPPES record last updated: January 5, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Southcom Clinic-ft. Gordon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHCOM CLINIC-FT. GORDON (NPI 1164636320) is a healthcare organization registered as a military/u.s. coast guard outpatient in Doral, Florida and active in the NPI registry since May 2007. The organization lists Marvin Primos, Ubo Manager, as its authorized official.

NPPES Registry Identity

NPI1164636320
Entity TypeOrganization
Primary Taxonomy261QM1100X
Legal Business NameEISENHOWER ARMY MEDICAL CENTER
Location Address3511 NW 91ST AVEDoral, FL 33172-1216
Mailing Address300 W Hospital Rd Bldg W, Attn Mchf-padFort Gordon, GA 30905-5741 · (706) 787-1125
Organization SubpartYes
Authorized OfficialMarvin PrimosUbo Manager · (706) 787-7204
Enumeration DateMay 9, 2007
Last NPPES UpdateJanuary 5, 2015
NPI 1164636320 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyClinic/Center · Military/U.S. Coast Guard OutpatientAmbulatory Health Care Facilities
Taxonomy Code261QM1100X
Definition
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.
Also ListedMilitary/U.S. Coast Guard PharmacyTaxonomy 332000000X
3511 NW 91ST AVE, Doral, FL 33172

Other Names 1

Doing Business AsSouthcom Clinic-ft. Gordon

Other Identifiers 3

Medicare UPINOTH000
Medicare UPINVAD000
Other1578660742Parent Mtf Npi

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant (Medical)
3511 NW 91ST AVE
DORAL, FL 33172
Physician Assistant
3511 NW 91ST AVE
DORAL, FL 33172
Family Medicine (Sports Medicine)
3511 NW 91ST AVE
DORAL, FL 33172

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eisenhower Army Medical Center's NPI number?

The NPI number for Eisenhower Army Medical Center is 1164636320. It was assigned to this organization in the NPPES registry on May 9, 2007. The provider is doing business as Southcom Clinic-Ft. Gordon.

Where is Eisenhower Army Medical Center located?

Eisenhower Army Medical Center is located at 3511 NW 91st Ave, Doral, FL 33172. The listed phone number is (305) 437-1970.

What is Eisenhower Army Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Military/U.S. Coast Guard Outpatient, with taxonomy code 261QM1100X.

When was this NPI record last updated?

The NPPES record for Eisenhower Army Medical Center was last updated on January 5, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.