1811201197 NPI number — MARTIN 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 1811201197 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:
Provider Other Organization Name Type Code:
6
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:
1811201197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 VAN AALST BLVD BLDG 9250
Provider Second Line Business Mailing Address:
ATTN MCXB-PP MEDDAC UNIFORM BUSINESS OFFICE
Provider Business Mailing Address City Name:
FORT BENNING
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:
7950 MARTIN LOOP
Provider Second Line Business Practice Location Address:
CBPCC 1 FORT BENNING
Provider Business Practice Location Address City Name:
FORT BENNING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31905-5648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-284-4588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
UBO MANAGER
Authorized Official Telephone Number:
706-544-5724

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)

  • Identifier: 1194730846 . This is a "PARENT BILLING NPI" identifier . This identifiers is of the category "OTHER".




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