Basic Information
| Provider Information | |||||||||
| NPI: | 1609017235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMACK ARMY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2817 REILLY ROAD | ||||||||
| Address2: | BUILDING 4 | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109079262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2817 REILLY ROAD | ||||||||
| Address2: | BUILDING 4 | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109079262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2009 | ||||||||
| LastUpdateDate: | 10/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF MEDICAL RESIDENTS | ||||||||
| AuthorizedOfficialTelephone: | 2027825584 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2865M2000X | Y | Hospitals | Military Hospital | Military General Acute Care Hospital |
No ID Information.