KIMBROUGH ACC MILITARY MTF (NPI# 1205242310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205242310 |
| Entity Type | Organization |
| Organization Name | KIMBROUGH ACC MILITARY MTF |
| Other Organization Name | DOD FT DETRICK EPHCY |
| Practice Address |
1434 Porter St Frederick MD 21702-9254 |
| Mailing Address |
Kimbrough Acc Military Mtf C/o Cdr Usameddac Mcxr-bd 2480 Luwellyn Ave Ste 5800 Ft Meade MD 20755-5129 |
| Practice Telephone | 3016196710 |
| Practice Fax Number | 3016196286 |
| Mailing Telephone | 3016196710 |
| Mailing Fax Number | 3016196286 |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2015-05-27 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2146748 | 01 |
| Other Name | Type Code |
|---|---|
| DoD FT DETRICK ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639667736 | Kimbrough Acc Military Mtf | Pharmacy | G-avenue, Bldg 400 Dept of Pharmacy, New Cumberland, PA 17070 | 2018-04-25 |
| 1457849556 | Kimbrough Acc Military Mtf | Pharmacy | Ft Indiantown Gap, Bldg 4-114, Annville, PA 17003 | 2018-04-25 |
| 1801206685 | Kimbrough Acc Military Mtf | Pharmacy | 2799 Rose Street, Ft Meade, MD 20755 | 2014-05-02 |
| 1871709576 | Kimbrough Acc Military Mtf | Clinic/Center | 99 G Street, Bldg 400, New Cumberland, PA 17070 | 2007-05-16 |
| 1417163114 | Kimbrough Acc Military Mtf | Clinic/Center | 1999 Fisher Ave, Fort Indiantown Gap, Annville, PA 17003 | 2007-05-16 |
| 1235345935 | Kimbrough Acc Military Mtf | Clinic/Center | Letterkenny Army Depot, Bldg 332, Chambersburg, PA 17201 | 2007-05-16 |
| 1689888455 | Kimbrough Acc Military Mtf | Military/U.S. Coast Guard Pharmacy | 103 3rd Ave, Building 58, Washington, DC 20319-5058 | 2007-05-10 |
| 1992108633 | Kimbrough Acc Military Mtf | Military/U.S. Coast Guard Pharmacy | 450 Gibner Rd, Carlisle, PA 17013-5090 | 2014-10-08 |
| 1316353782 | Kimbrough Acc Military Mtf | Pharmacy | 401 Carpenter Rd Bldg 525, Fort Myer, VA 22211-1009 | 2014-07-07 |
| 1437563871 | Kimbrough Acc Military Mtf | Pharmacy | 2480 Llewellyn Ave Ste 5800, Kimbrough Ambulatory Care Center, Fort Meade, MD 20755-5129 | 2014-06-13 |
| Street Address |
1434 PORTER ST |
| City | FREDERICK |
| State | MD |
| Zip Code | 21702-9254 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700174018 | Monica Ivone Zeballos | Pharmacist | 1434 Porter St, Frederick, MD 21702-9254 | 2011-07-20 |
| 1871766642 | Paul Denis Manny | Physical Therapist | 1434 Porter St, Frederick, MD 21702-9254 | 2008-04-11 |
| 1710106851 | Marie L Mcdonough | Registered Nurse | 1434 Porter St, Frederick, MD 21702-9210 | 2007-04-25 |
| 1548489685 | Erica Lashon Henderson | Licensed Practical Nurse | 1434 Porter St, Frederick, MD 21702-9210 | 2007-04-25 |
| 1841419801 | Gary Crotteau | Licensed Practical Nurse | 1434 Porter St, Frederick, MD 21702-9210 | 2007-04-25 |
| 1053530139 | Carol Tobias | Registered Nurse | 1434 Porter St, Frederick, MD 21702-9210 | 2007-04-25 |
| 1831318591 | Heidi Maria Chaney | Registered Nurse | 1434 Porter St, Frederick, MD 21702-9210 | 2007-04-24 |
| 1295954709 | Marilyn Lamb | Licensed Practical Nurse | 1434 Porter St, Frederick, MD 21702-9210 | 2007-04-24 |
| 1568681088 | Janice Condrey | Registered Nurse | 1434 Porter St, Frederick, MD 21702-9210 | 2007-04-24 |
| 1811029002 | Heather L Offutt | Specialist | 1434 Porter St, Frederick, MD 21702-9254 | 2007-03-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073129714 | Rita Akowuah | Nurse Practitioner | 1302 Baker Place East Apt 14, Frederick, MD 21702 | 2020-09-18 |
| 1912416272 | Morgan Nicely | Behavior Technician | 65 Thomas Johnson Drive Suite A, Frederick, MD 21702 | 2017-09-29 |
| 1154840494 | Centers for Advanced Orthopaedics, LLC | Orthopaedic Surgery | 184 Thomas Johnson Dr Ste 104, Frederick, MD 21702 | 2017-09-19 |
| 1831617471 | Hazel Elizabeth Gill | Physical Therapy Assistant | 2007 Butterfield Overlook, Frederick, MD 21702 | 2017-09-05 |
| 1831610161 | William Haynes | Nurse Practitioner | 103 Water Land Ct., Frederick, MD 21702 | 2017-06-27 |
| 1497299333 | Timothy Stimach | Pharmacist | 1430b W Patrick St, Frederick, MD 21702 | 2016-12-12 |
| 1184167405 | Maryland Nutrition and Diet Services, L.L.C. | Dietitian, Registered | 1301 W. 7th Street, No. 1607, Frederick, MD 21702 | 2016-11-18 |
| 1649649468 | Oluwakemi Olubunmi Osidele | Nurse Practitioner | 188 Thomas Johnson Dr Ste 102, Frederick, MD 21702 | 2015-09-22 |
| 1841678562 | Ventzislava Hristova | Spec/Tech, Pathology | 1050 Boyles St. Building 560 Room 12-39, National Cancer Institute - Frederick, Frederick, MD 21702 | 2015-05-14 |
| 1023404571 | Mychal Lynn Pilia | Advanced Practice Midwife | 7420 Hayward Road, Suite 104, Frederick, MD 21702 | 2015-04-11 |
| Find all providers in zip 21702 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649296815 | Kimbrough Acc Military Mtf | Military/U.S. Coast Guard Pharmacy | 1434 Porter St, Fort Detrick, Frederick, MD 21702-9210 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548868870 | Walter Reed National Military Medical Center | Military/U.S. Coast Guard Pharmacy | 101 Buchanan Rd, Annapolis, MD 21402-5107 | 2020-10-09 |
| 1184273195 | Naval Health Clinic Annapolis | Military/U.S. Coast Guard Pharmacy | 4141 W Wilson Rd Bldg 1600, Indian Head, MD 20640-5162 | 2019-09-11 |
| 1063763241 | National Naval Medical Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave Dept Ofphcy, Bldg 9, Room 2303, Bethesda, MD 20889-0001 | 2012-09-27 |
| 1902905318 | Naval Health Clinic Patuxent River | Military/U.S. Coast Guard Pharmacy | Bldg 1370, Patuxent River, MD 20670 | 2006-09-22 |
| 1679672083 | Dunham Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 1452 Porter St, Ft Detrick, MD 21702 | 2006-09-22 |
| 1851490270 | Malcom Grow Medical Center 79 Mdg Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1050 W Perimeter Rd # D1119, Jb Andrews, MD 20762-6601 | 2006-09-22 |
| 1174620926 | Naval Health Clinic Patuxent River | Military/U.S. Coast Guard Pharmacy | Bldg 1600 Wilson Drive, Indian Head, MD 20640 | 2006-09-20 |
| 1265539019 | Malcom Grow Medical Center 79 Mdg Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1 San Diego Loop Bldg 3188, Jb Andrews, MD 20762-5518 | 2006-09-20 |
| 1649682162 | Naval Health Clinic Annapolis | Military/U.S. Coast Guard Pharmacy | 695 Kinkaid Rd, Naval Health Clinic Annapolis, Annapolis, MD 21402 | 2014-06-02 |
| 1518379395 | Malcolm Grow Medical Clinic 779 Mdg | Military/U.S. Coast Guard Pharmacy | 1060 W Perimeter Rd, Joint Base Andrews, MD 20762-6602 | 2014-05-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.