MEDICARE: AMC WOMACK-FT BRAGG

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center
2	261QM1101X	Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
3	332000000X	Military/U.S. Coast Guard Pharmacy
4	341800000X	Military/U.S. Coast Guard Transport,
5	2865M2000X	Military General Acute Care Hospital

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

General Provider Information

NPI Number	:	1740377423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMC WOMACK-FT BRAGG

Provider Business Mailing Address
First Line	:	2817 REILLY ST
Second Line	:	MCXC-DBO-UB WAMC STOP A
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7301
Country	:	US
Telephone Number	:	910-907-6693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 REILLY ST
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-7301
Country	:	US
Telephone Number	:	910-907-9262
Fax Number	:

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	MARVIN PRIMOS
Credential	:
Telephone Number	:	910-907-8440

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	05/22/2025

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