Provider Demographics
NPI:1447359732
Name:WOMACK ARMY MEDICAL CENTER
Entity type:Organization
Organization Name:WOMACK ARMY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:WOMACK ARMY MEDICAL CTR 2817 REILLY RD
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7394
Mailing Address - Country:US
Mailing Address - Phone:910-907-6693
Mailing Address - Fax:910-432-4638
Practice Address - Street 1:LANE RD BLDG M4861
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-9099
Practice Address - Fax:910-432-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068470OtherPK
1740377423OtherPARENT FACILITY NPI
OTH000Medicare UPIN
VAD000Medicare UPIN
1962616490OtherFACILITY NPI
3437503OtherOTHER ID NUMBER-COMMERCIAL NUMBER