MEDICARE: WOMACK ARMY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0294A	OTHER	BCBS CMS 1500 PROVIDER ID
2	0465Y	OTHER	BCBS PHARMACY ID
3	00539	OTHER	BCBS UB-04 PROVIDER ID
4	1740377423	OTHER	PARENT FACILITY NPI

General Provider Information

NPI Number	:	1760795769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMACK ARMY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2817 REILLY ST
Second Line	:	MCXC-DBO-UB WAMC STOP A
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7324
Country	:	US
Telephone Number	:	910-907-6693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 BENTRIDGE LN
Second Line	:	WOODLAND BLDG
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-0586
Country	:	US
Telephone Number	:	910-907-9262
Fax Number	:

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	BARBARA BLACK
Credential	:
Telephone Number	:	910-907-8537

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	02/11/2013

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