Healthcare Provider Details

I. General information

NPI: 1194138859
Provider Name (Legal Business Name): AHC MONCRIEF-JACKSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

MONCRIEF ARMY COMMUNITY HOSPITAL 4500 STUART ST BOX 497
FORT JACKSON SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-7979
  • Fax: 803-751-2048
Mailing address:
  • Phone: 803-751-2415
  • Fax: 803-751-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650