# KIMBROUGH AMBULATORY CARE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679622658
- **Authorized official:** MRS. TAMMIE F CONAWAY-MANSON LPN (LPM)
- **Authorized official phone:** (301) 677-8771

## Contact information

- **Practice address:** 2480 LLEWELLYN AVE, FORT GEORGE G MEADE, MD 20755-5800
- **Practice address phone:** (301) 677-8771
- **Mailing address:** 311 REGIMENT CT, ODENTON, MD 21113-2617

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 08/22/2020