Provider Demographics
NPI:1538251764
Name:AMC BAMC-FSH
Entity type:Organization
Organization Name:AMC BAMC-FSH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C, UBO
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-539-7197
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:MCHE-COU-T, DEPT 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4513
Mailing Address - Country:US
Mailing Address - Phone:210-916-8558
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-4682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMC BAMC-FSH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care HospitalGroup - Multi-Specialty
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No341800000XTransportation ServicesMilitary/U.S. Coast Guard Transport
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AN2598588OtherMEDCO
TXHH6041OtherBC/BS PROVIDER NUMBER
TX35JKOtherBC BS PROVIDER
4503884OtherNCPDP
OTH000Medicare UPIN
VAD000Medicare UPIN