Organization
MARTIN ARMY COMMUNITY HOSPITAL
Active
Parent organization
MARTIN ARMY COMMUNITY HOSPITAL
Other names
TMC EGLIN AFB
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARTIN ARMY COMMUNITY HOSPITAL
Authorized official
KERTREDIA DAVIS (UBO MANAGER)
(762) 408-0007
Entity
Organization
Contact information
Practice address
6069 WALKERS LN, TMC 12 CAMP RUDDER, EGLIN AFB, FL 32542-8505
(850) 882-1170
Mailing address
6600 VAN AALST BLVD BLDG 9250, ATTN TREASURY MCXB-PP, FORT BENNING, GA 31905-2102
(762) 408-2273
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194730846
PARENT FACILITY NPI
—
Enumeration date
08/27/2008
Last updated
01/20/2021
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