KIMBROUGH ACC MILITARY MTF (NPI# 1316353782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316353782 |
| Entity Type | Organization |
| Organization Name | KIMBROUGH ACC MILITARY MTF |
| Other Organization Name | DOD FT MYER EPHCY |
| Practice Address |
401 Carpenter Rd Bldg 525 Fort Myer VA 22211-1009 |
| Mailing Address |
Kimbrough Acc Military Mtf C/o Cdr Usameddac Mcxr-bd2480 Luwellyn Ave Ste 5800 Ft Meade MD 20755 |
| Practice Telephone | 7036963616 |
| Practice Fax Number | 7036960276 |
| Mailing Telephone | 7036963616 |
| Mailing Fax Number | 7036960276 |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2016-01-11 |
| 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 |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2146666 | 01 |
| Other Name | Type Code |
|---|---|
| DoD FT MYER 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 |
| 1205242310 | Kimbrough Acc Military Mtf | Military/U.S. Coast Guard Pharmacy | 1434 Porter St, Frederick, MD 21702-9254 | 2014-07-09 |
| 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 |
401 CARPENTER RD BLDG 525 |
| City | FORT MYER |
| State | VA |
| Zip Code | 22211-1009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386620680 | Jeffery Scott Porter | Pediatrics | 401 Carpenter Rd Bldg 525, Room 120, Fort Myer, VA 22211-1009 | 2005-12-19 |
| 1912333600 | Katherine A Kingsford | Registered Nurse | 401 Carpenter Rd Bldg 525, Andrew Rader Us Army Health Clinic, Fort Myer, VA 22211-1009 | 2013-09-25 |
| 1841432036 | Thomas Moore Lehmann | Pharmacist | 401 Carpenter Rd Bldg 525, Fort Myer, VA 22211-1009 | 2009-04-02 |
| 1740365493 | Shirley Becton Mckenzie | Nurse Practitioner | 401 Carpenter Rd Bldg 525, 1015, Fort Myer, VA 22211-1009 | 2006-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386113306 | Caroline Vickers | Physician Assistant | Radar Us Army Health Clinic, 401 Carpenter Road, Fort Myer, VA 22211 | 2018-11-20 |
| 1326371212 | Jeffrey Alan Anderson | Physician Assistant | 410 Sheridan Ave - 529th Rsc, Attn: Regimental Aid Station, Fort Myer, VA 22211 | 2009-09-10 |
| 1194706820 | Joel Margolis | Podiatrist | 525 Carpenter Road, Rader Clinic, Ft. Myer, VA 22211 | 2005-11-09 |
| 1891772976 | Camille B Diclerico | Registered Nurse | 401 Carpenter Rd, Rader Army Clinic, Fort Myer, VA 22211 | 2005-12-29 |
| 1124000492 | Peter Contos II | Physical Therapist | 401 Carpenter Road, Building #525, Arlington, VA 22211 | 2005-11-14 |
| 1205817962 | Sharon L Gray | Social Worker | 525 Carpenter Road, Fort Myer, VA 22211 | 2005-11-09 |
| 1225028590 | Marvin E Bloom | Family Medicine | 450 Carpenter Rd, Rader Clinic, Ft Myer, VA 22211-1008 | 2005-10-26 |
| 1033533039 | Jacqueline H Ware | Pharmacist | 401 Carpenter Road, Bldg 525, Andrew Rader Us Army Health Clinic, Ft Myer, VA 22211-1009 | 2014-02-11 |
| 1306149182 | Crystal Lynn Sims | Physical Therapist | 401 Carpenter Rd Ste 1, Fort Myer, VA 22211-1009 | 2010-12-16 |
| 1457349482 | Thomas Joseph Decoster | Counselor | 401 Carpenter Rd, Ft Myer, VA 22211-1009 | 2005-10-13 |
| Find all providers in zip 22211 | ||||
| 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 |
|---|---|---|---|---|
| 1477866143 | Kimbrough Acc Military Mtf | Military/U.S. Coast Guard Pharmacy | 401 Carpenter Rd, Building 525 Room 1024, Fort Myer, VA 22211-1009 | 2010-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174172183 | Naval Health Clinic Annapolis | Military/U.S. Coast Guard Pharmacy | 17457 Caffee Rd Bldg 192, Dahlgren, VA 22448-5120 | 2019-09-11 |
| 1114403961 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | 7021 Harbor View Blvd, Suffolk, VA 23435-2869 | 2018-07-16 |
| 1437563269 | Fort Belvoir Community Hospital | Military/U.S. Coast Guard Pharmacy | 8651 John J Kingman Rd, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060-6200 | 2014-06-19 |
| 1508270950 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | 1011 Eden Way N Ste H, Chesapeake, VA 23320-2768 | 2014-06-13 |
| 1205249059 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | 1647 Admiral Taussig Blvd Bldg Cd2, Norfolk, VA 23511-2803 | 2014-06-10 |
| 1467680819 | World Class Marketing Inc | Military/U.S. Coast Guard Pharmacy | 1814 Kecoughtan Rd, Suite B, Hampton, VA 23661-2834 | 2009-06-24 |
| 1609966936 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | Naval Weapons Station Yorktown, Bldg 1806, Yorktown, VA 23691-0090 | 2006-10-16 |
| 1982703013 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg 3219, Ft Lee, VA 23801 | 2006-09-22 |
| 1922107044 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg P8130, Ft Lee, VA 23801 | 2006-09-22 |
| 1659470771 | 1st Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 65 Spaatz Dr, Langley Afb, VA 23665-2027 | 2006-09-22 |
| Find all providers with the same taxonomy | ||||
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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.