Provider Demographics
NPI:1841390077
Name:AMC MADIGAN-FT LEWIS
Entity type:Organization
Organization Name:AMC MADIGAN-FT LEWIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UNIFORM BUSINESS OFFICE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-968-1110
Mailing Address - Street 1:9040 JACKSON AVE
Mailing Address - Street 2:ATTN: MCHJ-CSR-U
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-1110
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMC MADIGAN-FT LEWIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No341800000XTransportation ServicesMilitary/U.S. Coast Guard Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3318904Medicaid
WA4927464OtherNCPDP
WAAN2598588OtherMEDCO
WA4927464OtherNCPDP
WA3318904Medicaid
WA50005EMedicare Oscar/Certification
WA4927464OtherNCPDP