Provider Demographics
NPI:1124223797
Name:KIMBROUGH ACC MILITARY MTF
Entity Type:Organization
Organization Name:KIMBROUGH ACC MILITARY MTF
Other - Org Name:USADC EPES-MEADE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-677-8512
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:CDR USAMEDDAC MCXR-BD STE 5800
Mailing Address - City:FORT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-7081
Mailing Address - Country:US
Mailing Address - Phone:301-677-8253
Mailing Address - Fax:
Practice Address - Street 1:8472 SIMMOND ST
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5700
Practice Address - Country:US
Practice Address - Phone:301-677-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBROUGH ACC MILITARY MTF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient