# MARTIN ARMY COMMUNITY HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARTIN ARMY COMMUNITY HOSPITAL
- **Other names:** TMC EGLIN AFB
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1164679601
- **Legal business name:** MARTIN ARMY COMMUNITY HOSPITAL
- **Authorized official:** KERTREDIA DAVIS (UBO MANAGER)
- **Authorized official phone:** (762) 408-0007

## Contact information

- **Practice address:** 6069 WALKERS LN, TMC 12 CAMP RUDDER, EGLIN AFB, FL 32542-8505
- **Practice address phone:** (850) 882-1170
- **Mailing address:** 6600 VAN AALST BLVD BLDG 9250, ATTN TREASURY MCXB-PP, FORT BENNING, GA 31905-2102
- **Mailing address phone:** (762) 408-2273

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 08/27/2008
- **Last updated:** 01/20/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1194730846 | PARENT FACILITY NPI | — |