NPIMap

Organization Active NPI

Martin Army Community Hospital

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Eglin Afb, FL
National Provider Identifier
1164679601
Registry record updated Jan 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
MARTIN ARMY COMMUNITY HOSPITAL
Doing business as
TMC EGLIN AFB
Practice address
6069 Walkers LN
TMC 12 Camp Rudder
Eglin Afb, FL 32542-8505
Phone
(850) 882-1170
NPI assigned
Aug 27, 2008
Organization subpart
Yes
Parent organization
MARTIN ARMY COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2021

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

Authorized official

Name
Kertredia Davis
Title
Ubo Manager
Phone
(762) 408-0007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary

Addresses

Primary practice location

6069 Walkers LN
TMC 12 Camp Rudder
Eglin Afb, FL 32542-8505

Mailing address

6600 Van Aalst Blvd BLDG 9250
Attn Treasury MCXB-PP
Fort Benning, GA 31905-2102
Phone (762) 408-2273

Other identifiers 1

IdentifierTypeStateIssuer
1194730846OtherPARENT FACILITY NPI

Other names 1

  • TMC EGLIN AFB Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Martin Army Community Hospital28 organizations share this tax ID, including this one
Part of
Martin Army Community Hospital

Other organizations with this tax ID 27

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

View all 27

Locations

6069 Walkers Ln
#12
Eglin AFB, FL 32542
Phone (850) 882-1170

NPI Registry JSON

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1164679601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD BLDG 9250",
            "address_2": "ATTN TREASURY MCXB-PP",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "762-408-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6069 WALKERS LN",
            "address_2": "TMC 12 CAMP RUDDER",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325428505",
            "telephone_number": "850-882-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN ARMY COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARTIN ARMY COMMUNITY HOSPITAL",
        "enumeration_date": "2008-08-27",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KERTREDIA",
        "authorized_official_title_or_position": "UBO MANAGER",
        "authorized_official_telephone_number": "762-408-0007"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARENT FACILITY NPI",
            "identifier": "1194730846",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TMC EGLIN AFB",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TMC EGLIN AFB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eglin Afb, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.