Provider Demographics
NPI:1932315074
Name:WOMACK ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:WOMACK ARMY MEDICAL CENTER
Other - Org Name:USAOHC FT. BRAGG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-907-8537
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:MCXC-DBO-UB WAMC STOP A
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-6693
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:BLDG 4-2817 1ST FLOOR
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-9262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMACK ARMY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
0465YOtherBCBS PHARMACY ID
00539OtherBCBS UB-04 PROVIDER ID
0294AOtherBCBS CMS 1500 PROVIDER ID
1740377423OtherPARENT FACILITY NPI
0465YOtherBCBS PHARMACY ID
OTH000Medicare UPIN