OrganizationBranch Medical Clinic Edson RangeClinic/CenterAmbulatory Health Care FacilitiesPractice AddressStuart Mesa Rd, Bldg 310514, Box 555191, Camp Pendleton, CA 92055-5191(760) 725-1621PECOS EnrollmentBased on the most recent information from CMS, provider Branch Medical Clinic Edson Range does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1912100983Provider TypeOrganizationFull NameBranch Medical Clinic Edson RangeSubpartYesEnumeration Date6/7/2007Last Updated10/16/2017Contact InformationPractice LocationPractice AddressStuart Mesa Rd, Bldg 310514, Box 555191, Camp Pendleton, CA 92055-5191Phone(760) 725-1621Fax(760) 725-1661Mailing LocationMailing AddressPO Box 555191, Fin Mgmt Code 0814, Camp Pendleton, CA 92055-5191Phone(760) 725-1621Fax(760) 725-1661Authorized OfficialNameCondon, William M (Bumed Ubo)Phone(240) 401-3643Provider TaxonomiesCodeDescriptionLicenseCode261QM1100XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1386604387DescriptionOtherIssuerPARENT FACILITY NPICalifornia