Provider Demographics
NPI:1508163098
Name:AMC WOMACK-FT BRAGG
Entity type:Organization
Organization Name:AMC WOMACK-FT BRAGG
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:WOMACK ARMY MEDICALCENTER 2817 REILLY RD
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7394
Mailing Address - Country:US
Mailing Address - Phone:910-907-6693
Mailing Address - Fax:
Practice Address - Street 1:2356 SOUTH PEAK DRIVE
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348
Practice Address - Country:US
Practice Address - Phone:910-908-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMC WOMACK-FT BRAGG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128930OtherPK
OTH000Medicare UPIN
VAD000Medicare UPIN
1740377423OtherPARENT FACILITY - WOMACK ARMY MEDICAL CENTER NPI
0465YOtherBCBS PHARMACY ID
1134433402OtherFACILITY - HOPE MILLS MEDICAL HOME-BRAGG NPI