Organization
AMC WOMACK-FT BRAGG
Active
Organization
AMC WOMACK-FT BRAGG
Active
Parent organization
AMC WOMACK-FT BRAGG
Other names
WAMC
Organization subpart
Yes
Provider details
NPI number
Legal business name
AMC WOMACK-FT BRAGG
Authorized official
MARVIN PRIMOS (UBO MANAGER)
(910) 907-8440
Entity
Organization
Contact information
Practice address
2817 REILLY ST, FORT BRAGG, NC 28310-7301
(910) 907-9262
Mailing address
2817 REILLY ST, MCXC-DBO-UB WAMC STOP A, FORT BRAGG, NC 28310-7301
(910) 907-6693
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
—
—
2865M2000X
Military General Acute Care Hospital
Primary
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
341800000X
Military/U.S. Coast Guard Transport
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00539
BCBS UB-04 PROVIDER ID
—
01
—
0294A
BCBS CMS 1500 PROVIDER ID
—
01
—
0465Y
BCBS PHARMACY ID
—
Enumeration date
10/06/2006
Last updated
05/22/2025
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