1457781833 NPI number — WINN 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 1457781833 NPI number — WINN ARMY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINN 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:
Provider Other Organization Name Type Code:
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:
1457781833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 HARMON AVE
Provider Second Line Business Mailing Address:
WINN ARMY COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
FORT STEWART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31314-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-435-6933
Provider Business Mailing Address Fax Number:
912-435-5966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1061 HARMON AVE
Provider Second Line Business Practice Location Address:
WINN ARMY COMMUNITY HOSPITAL; CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
FORT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-5641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-435-6933
Provider Business Practice Location Address Fax Number:
912-435-5966
Provider Enumeration Date:
11/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ODOM
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALS MANAGER
Authorized Official Telephone Number:
912-435-6933

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  C008473 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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