Provider Demographics
NPI:1902091044
Name:BRANCH HEALTH CLINIC SOUDA BAY
Entity Type:Organization
Organization Name:BRANCH HEALTH CLINIC SOUDA BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUMED UBO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:PSC 836
Mailing Address - Street 2:BOX 2670
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636-9998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 814
Practice Address - Street 2:BOX 19
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09865
Practice Address - Country:US
Practice Address - Phone:011-390-9556
Practice Address - Fax:0113909-556-3898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL SIGONELLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-12
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherBRANCH HEALTH CLINIC SOUD