Basic Information
| Provider Information | |||||||||
| NPI: | 1508163098 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMACK ARMY MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | BRAGG CBPCC HM PHCY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | WOMACK ARMY MEDICALCENTER | ||||||||
| Address2: | 2817 REILLY RD | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283107394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109076693 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2356 SOUTH PEAK DRIVE | ||||||||
| Address2: | |||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109084673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2011 | ||||||||
| LastUpdateDate: | 06/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | MORALES | ||||||||
| AuthorizedOfficialFirstName: | HECTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF DHA PASS | ||||||||
| AuthorizedOfficialTelephone: | 2105366650 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332000000X | Y | Suppliers | Military/U.S. Coast Guard Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2128930 | 01 | PK | OTHER |