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General NPI Number Information
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NPI Number | 1386652956
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Entity Type | Organization
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Legal Business Name | AHC MONCRIEF-JACKSON
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 4500 STUART ST
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City | FORT JACKSON
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State | SC
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Zip | 29207-5720
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Country | US
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Telephone | 803-751-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 STUART ST BOX 497
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City | FORT JACKSON
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State | SC
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Zip | 29207-5720
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Country | US
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Telephone | 803-751-0472
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Fax | 803-751-0415
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Authorized Official
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Title or Position | UBO MANAGER
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Name | MARIYE MCCRAY
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Credential |
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Telephone | 803-751-0472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 261QM1101X
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Taxonomy Name | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
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License Number |
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number |
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License Number State | SC
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