Provider Demographics
NPI:1437563871
Name:KIMBROUGH ACC MILITARY MTF
Entity Type:Organization
Organization Name:KIMBROUGH ACC MILITARY MTF
Other - Org Name:DOD FT MEADE EPHCY
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:KIMBROUGH ACC MILITARY MTF
Mailing Address - Street 2:CO CDR USAMEDDAC MCXR-BD 2480 LUWELLYN AVE STE 5800
Mailing Address - City:FT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5129
Mailing Address - Country:US
Mailing Address - Phone:301-677-8800
Mailing Address - Fax:301-677-8456
Practice Address - Street 1:2480 LLEWELLYN AVE STE 5800
Practice Address - Street 2:KIMBROUGH AMBULATORY CARE CENTER
Practice Address - City:FORT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5129
Practice Address - Country:US
Practice Address - Phone:301-677-8800
Practice Address - Fax:301-677-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146217OtherPK