Organization
BRANCH MEDICAL CLINIC MCAS NEW RIVER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM M CONDON (BUMED UBO)
(240) 401-3643
Entity
Organization
Contact information
Practice address
100 BREWSTER BLVD - CODE 08/ZD, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
Mailing address
100 BREWSTER BLVD - CODE 08/ZD, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
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
—
VAD000
UPIN
NC
Enumeration date
09/11/2007
Last updated
10/15/2017
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