Organization
BRANCH MEDICAL CLINIC CHINA LAKE
Active
Parent organization
NAVAL HOSPITAL TWENTYNINE PALMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
NAVAL HOSPITAL TWENTYNINE PALMS
Authorized official
WILLIAM M CONDON (BUMED UBO)
(240) 401-3643
Entity
Organization
Contact information
Practice address
1 ADMINISTRATION CIR, RIDGECREST, CA 93555-6104
(760) 830-2498
(760) 830-2182
Mailing address
1 ADMINISTRATION CIR, RIDGECREST, CA 93555-6104
(760) 830-2498
(760) 830-2182
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5662
BLUE CROSS BLUE SHIELD
CA
01
—
NOT REQUIRED
MAILHANDLERS BENEFIT PLAN
CA
Enumeration date
06/14/2007
Last updated
10/16/2017
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