NPIMap

Organization Active NPI

Ft Meade Meddac

  • Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
  • Fort Meade, MD
National Provider Identifier
1164507703
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military and U.S. Coast Guard Ambulatory Procedure Clinic/CenterTaxonomy code 261QM1101X
Legal business name
FT MEADE MEDDAC
Practice address
2480 Llewellyn Ave
Fort Meade, MD 20755-5800
Phone
(301) 677-8800
NPI assigned
Oct 25, 2006
Last updated
May 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
FT MEADE MEDDACAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terri Kimbrow
Title
Ubo Manager
Phone
(301) 677-8512

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center 261QM1101X Primary
Military/U.S. Coast Guard Pharmacy 332000000X

Addresses

Primary practice location

2480 Llewellyn Ave
Fort Meade, MD 20755-5800

Mailing address

2480 Llewellyn Ave
CDR Usameddac MCXR-BD Ste 5800
Fort Meade, MD 20755-7081
Phone (301) 677-8800

Other identifiers 3

IdentifierTypeStateIssuer
1447357298 / 2125284OtherPHARMACY NPI/NCPDP
AN2598588OtherMEDCO
02DTOtherBCBS FEDERAL

Other names 1

  • KIMBROUGH AMBULATORY CARE CENTER-MEADE Other name

National Provider Directory

National Provider Directory
Tax ID family
Ft Meade Meddac25 organizations share this tax ID, including this one
Part of
Ft Meade Meddac

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1164507703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "address_2": "CDR USAMEDDAC MCXR-BD STE 5800",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207557081",
            "telephone_number": "301-677-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207555800",
            "telephone_number": "301-677-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT MEADE MEDDAC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FT MEADE MEDDAC",
        "enumeration_date": "2006-10-25",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A",
        "authorized_official_last_name": "KIMBROW",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "UBO MANAGER",
        "authorized_official_telephone_number": "301-677-8512"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY NPI/NCPDP",
            "identifier": "1447357298 / 2125284",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCO",
            "identifier": "AN2598588",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEDERAL",
            "identifier": "02DT",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIMBROUGH AMBULATORY CARE CENTER-MEADE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Meade, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.