Provider Demographics
NPI:1053618546
Name:BROOKE ARMY MEDICAL CENTER
Entity type:Organization
Organization Name:BROOKE ARMY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSTALLATION DIRECTOR OF PSYCH
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-526-7155
Mailing Address - Street 1:6501 FM 3009
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154
Mailing Address - Country:US
Mailing Address - Phone:210-916-6570
Mailing Address - Fax:
Practice Address - Street 1:6501 FM 3009
Practice Address - Street 2:SUITE 210
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154
Practice Address - Country:US
Practice Address - Phone:210-916-6570
Practice Address - Fax:210-916-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128923OtherPK