Organization
KIMBROUGH ACC MILITARY MTF
Active
Parent organization
KIMBROUGH ACC MILITARY MTF
Other names
AHC MCNAIR-MYER-HENDERSON HALL
Organization subpart
Yes
Provider details
NPI number
Legal business name
KIMBROUGH ACC MILITARY MTF
Authorized official
TERRI KIMBROW (UBO MANAGER)
(301) 677-8512
Entity
Organization
Contact information
Practice address
103 3RD AVE, BUILDING 58, WASHINGTON, DC 20319-5058
(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
Primary
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164507703
PARENT FACILITY NPI 2 EFF 1 OCT 10
—
01
—
AN2598588
MEDCO
—
Enumeration date
05/10/2007
Last updated
04/01/2015
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