1376749838 NPI number — MONCRIEF ARMY COMMUNITY HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376749838 NPI number — MONCRIEF ARMY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONCRIEF ARMY COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
USADC HAGEN-JACKSON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376749838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4500 STUART ST
Provider Second Line Business Mailing Address:
BOX 497
Provider Business Mailing Address City Name:
FORT JACKSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29207-5720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-751-0472
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5330 MOSBY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT JACKSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-751-3255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARREN
Authorized Official First Name:
WILLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF, UBO
Authorized Official Telephone Number:
803-751-0472

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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