KIMBROUGH ACC MILITARY MTF (NPI# 1689888455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689888455 |
| Entity Type | Organization |
| Organization Name | KIMBROUGH ACC MILITARY MTF |
| Other Organization Name | AHC MCNAIR-MYER-HENDERSON HALL |
| Practice Address |
103 3rd Ave Building 58 Washington DC 20319-5058 |
| Mailing Address |
2480 Llewellyn Ave Cdr Usameddac Mcxr-bd Ste 5800 Fort Meade MD 20755-7081 |
| Practice Telephone | 3016778800 |
| Mailing Telephone | 3016778800 |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-04-01 |
| Authorized Official Name | TERRI KIMBROW (UBO MANAGER) |
| Authorized Official Telephone | 3016778512 |
| Is Organization Subpart | Y |
| Parent Organization Name | KIMBROUGH ACC MILITARY MTF |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PARENT FACILITY NPI 2 EFF 1 OCT 10 | 1164507703 | 01 | |
| MEDCO | AN2598588 | 01 |
| Other Name | Type Code |
|---|---|
| AHC MCNAIR-MYER-HENDERSON HALL | 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 |
| 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 |
| 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 |
103 3RD AVE BUILDING 58 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20319-5058 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205254901 | Megan Lorenz | Registered Nurse | 114 1st Ave, Bldg 58, Washington, DC 20319-5052 | 2014-04-01 |
| 1780734541 | Michael Matthew Barna | Family Medicine | 408 4th Ave, Washington, DC 20319-5062 | 2007-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205437993 | Rhonda Allman | Technician | 3118 Harris Hwy, Washington, WV 26181-8709 | 2020-11-08 |
| 1841891538 | Deidra Montgomery | Technician | 1402 Lake Washington Rd, Washington, WV 26181-8222 | 2020-11-08 |
| 1033710793 | Mykeena Naylor | Technician | 7 U St Nw, Washington, DC 20001-1010 | 2020-11-07 |
| 1942801683 | Jacquise C Martin | Technician | 2801 14th St Nw Apt 303, Washington, DC 20009-4946 | 2020-11-07 |
| 1497356133 | Deonta Marcell Saleem | Technician | 2400 Hartford St Se Apt 104, Washington, DC 20020-7967 | 2020-11-07 |
| 1033710959 | Wanda H. Rappaport | Psychologist | 2440 M Street, Nw, Suite 512, Washington, DC 20037 | 2020-11-06 |
| 1811598709 | Emily Ann Brown | Nutritionist | 4316 Alabama Ave Se, Washington, DC 20019-3001 | 2020-11-05 |
| 1447851548 | Caroline Nadine Hudgens | Technician | 2412 Wagner St Se, Washington, DC 20020-3416 | 2020-11-04 |
| 1255932380 | Donald Anthony Harris | Technician | 1924 Savannah St Se, Washington, DC 20020-7535 | 2020-11-04 |
| 1528669819 | Lyndell Neal Simms | Technician | 7053 Spring Pl Nw Apt 313, Washington, DC 20012-2193 | 2020-11-04 |
| Find all providers in WASHINGTON | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265639918 | Branch Medical Clinic Washington Navy Yard | Clinic/Center | 915 N Street Southeast, Suite 210, Washington, DC 20374-5162 | 2007-06-27 |
| 1881897544 | National Naval Medical Center | Clinic/Center | The Pentagon, Corridor 8, Washington, DC 20310-0001 | 2007-06-08 |
| 1467538371 | Uscg Headquarters Support Command (k) | Clinic/Center | Comdt 2100 2nd St Sw, Cg-1122, Suite 5314, Washington, DC 20593-0001 | 2006-10-31 |
| 1033312798 | Wramc | Clinic/Center | 6900 Georgia Ave, Usadc, Washington, DC 20310-0001 | 2007-06-08 |
| 1205042926 | Wramc | Clinic/Center | Pentagon, Washington, DC 20310-0001 | 2007-05-16 |
| 1285759712 | Uscg Ralph Nix Medical | Clinic/Center | Uscg Hq Comdt (cg-1122), 2100 Second Street South West, Washington, DC 20593-0001 | 2007-03-21 |
| 1740325380 | Uscg Air Station Barbers Point Clinic | Clinic/Center | Comdt Cg-1122, Washington, DC 20593-0001 | 2007-02-21 |
| 1326191073 | U.s Coast Guard | Clinic/Center | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2007-01-18 |
| 1003968942 | Uscg Isc San Pedro Clinic | Clinic/Center | 2100 2nd St Sw, Suite 5314, Washington, DC 20593-0002 | 2007-01-18 |
| 1477538361 | Uscg Air Station Port Angeles Medcial/dental Clinic | Clinic/Center | Commandant Uscg Hq (cg-1122), 2100 2nd Street, Washington, DC 20593-0001 | 2005-12-13 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20319 |
Please comment or provide details below to improve the information on KIMBROUGH ACC MILITARY MTF.
| 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.