Provider Demographics
NPI:1649379314
Name:MARTIN ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:MARTIN ARMY COMMUNITY HOSPITAL
Other - Org Name:DOD FT MOORE MAIN OP 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:MARTIN ARMY COMMUNITY HOSPITAL C/O MCXB-PP MEDDAC
Mailing Address - Street 2:6600 VAN AALST BLVD BLDG 9250
Mailing Address - City:FT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2102
Mailing Address - Country:US
Mailing Address - Phone:762-408-2273
Mailing Address - Fax:
Practice Address - Street 1:MARNE RD BLDG 9200
Practice Address - Street 2:
Practice Address - City:FT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-1049
Practice Address - Fax:706-544-1869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020268OtherPK
1194730846OtherPARENT NPI
1146857OtherOTHER ID NUMBER-COMMERCIAL NUMBER