Basic Information
| Provider Information | |||||||||
| NPI: | 1013148345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMACK ARMY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2817 REILLY RD MCXC-COD CREDENTIALS | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Practice Location | |||||||||
| Address1: | WOMACK ARMY MEDICAL CENTER 2817 REILLY RD | ||||||||
| Address2: | FAMILY MEDICINE CLINIC | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078007 | ||||||||
| FaxNumber: | 9109078630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2009 | ||||||||
| LastUpdateDate: | 08/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | LINDENMUTH | ||||||||
| AuthorizedOfficialFirstName: | LEIGH-ANNE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9109078922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | 390200000X | Y | Hospitals | Military Hospital |
No ID Information.