Organization
AHC MONCRIEF-JACKSON
Active
Parent organization
AHC MONCRIEF-JACKSON
Other names
ACH MONCRIEF-JACKSON
Organization subpart
Yes
Provider details
NPI number
Legal business name
AHC MONCRIEF-JACKSON
Authorized official
MARIYE MCCRAY (UBO MANAGER)
(803) 751-0472
Entity
Organization
Contact information
Practice address
4500 STUART ST, FORT JACKSON, SC 29207-5720
(803) 751-2160
Mailing address
4500 STUART ST, BOX 497, FORT JACKSON, SC 29207-5720
(803) 751-0472
(803) 751-0415
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
SC
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
SC
2865M2000X
Military General Acute Care Hospital
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42-22802
NCPDP
—
01
—
AN2598588
MEDCO ID
—
Enumeration date
08/03/2006
Last updated
05/22/2025
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