Provider Demographics
NPI:1316044175
Name:FORT BELVOIR COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:FORT BELVOIR COMMUNITY HOSPITAL
Other - Org Name:WOODBRIDGE MAIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:ATTN: TPCP
Mailing Address - City:FT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-2849
Mailing Address - Fax:
Practice Address - Street 1:3700 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2050
Practice Address - Country:US
Practice Address - Phone:703-491-7668
Practice Address - Fax:703-550-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105188OtherPK
005335OtherNCPDP PAYMENT CENTER
4836346OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1285849000OtherPARENT FACILITY DUMFRIES HEALTH CENTER NPI