Healthcare Provider Details

I. General information

NPI: 1962616490
Provider Name (Legal Business Name): WOMACK ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6744 LOGISTICS AVE BLDG M-4861
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

2817 REILLY ST MCXC-DBO-UB WAMC STOP A
FORT BRAGG NC
28310-7324
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-9262
  • Fax:
Mailing address:
  • Phone: 910-907-6693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA BLACK
Title or Position: UBO MANAGER
Credential:
Phone: 910-907-8537