Organization
FT MEADE MEDDAC
Active
Parent organization
FT MEADE MEDDAC
Other names
KIMBROUGH AMBULATORY CARE CENTER-MEADE
Organization subpart
Yes
Provider details
NPI number
Legal business name
FT MEADE MEDDAC
Authorized official
TERRI KIMBROW (UBO MANAGER)
(301) 677-8512
Entity
Organization
Contact information
Practice address
2480 LLEWELLYN AVE, FORT MEADE, MD 20755-5800
(301) 677-8800
Mailing address
2480 LLEWELLYN AVE, CDR USAMEDDAC MCXR-BD STE 5800, FORT MEADE, MD 20755-7081
(301) 677-8800
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
Primary
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02DT
BCBS FEDERAL
—
01
—
1447357298 / 2125284
PHARMACY NPI/NCPDP
—
01
—
AN2598588
MEDCO
—
Enumeration date
10/25/2006
Last updated
05/21/2025
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