1548369150 NPI number — MARTIN ARMY COMMUNITY HOSPITAL

Table of content: (NPI 1548369150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548369150 NPI number — MARTIN ARMY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN 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:
DOD FT MOORE REFILL PHARMACY
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:
1548369150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MARTIN ARMY COMMUNITY HOSPITAL C/O MCXB-PP MEDDAC
Provider Second Line Business Mailing Address:
6600 VAN AALST BLVD BLDG 9250
Provider Business Mailing Address City Name:
FT MOORE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31905-2102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
762-408-2273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARNE RD BLDG 9230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-544-4666
Provider Business Practice Location Address Fax Number:
706-544-1869
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF DHA PASS
Authorized Official Telephone Number:
210-536-6650

Provider Taxonomy Codes

  • Taxonomy code: 332000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2020269 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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