Provider Demographics
NPI:1235442328
Name:ACH WINN-FT STEWART
Entity type:Organization
Organization Name:ACH WINN-FT STEWART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF, UBO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-801-6238
Mailing Address - Street 1:1061 HARMON AVE STE 1D03
Mailing Address - Street 2:C/O WINN-THIRD PARTY INSURANCE
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6037
Mailing Address - Fax:
Practice Address - Street 1:2451A HWY 17
Practice Address - Street 2:STATION SHOPPING CENTER
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6422
Practice Address - Country:US
Practice Address - Phone:912-435-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACH WINN-FT STEWART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-19
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225081136OtherPARENT FACILITY WINN ACH NPI