NPIMap

Organization Active NPI

Martin Army Community Hospital

Doing business as Usadc Ft. Benning Love

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Fort Benning, GA
National Provider Identifier
1174726640
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
Usadc Ft. Benning Love
Practice address
7101 Hoff St
Building 9240
Fort Benning, GA 31905-5645
Phone
(706) 544-2051
NPI assigned
Jun 11, 2007
Last updated
Jan 20, 2021By the provider in NPPES
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, CRCR, CHLIS CRCR CCA
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

7101 Hoff St
Building 9240
Fort Benning, GA 31905-5645

Mailing address

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

Other names 1

  • USADC FT. BENNING LOVE 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

7101 Hoff St
Bldg 9240
Fort Moore, GA 31905
Phone (706) 544-3103

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1174726640",
    "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": "7101 HOFF ST",
            "address_2": "BUILDING 9240",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "319055645",
            "telephone_number": "706-544-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN ARMY COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARTIN ARMY COMMUNITY HOSPITAL",
        "enumeration_date": "2007-06-11",
        "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",
        "authorized_official_credential": "CRCR, CHLIS CRCR CCA"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "USADC FT. BENNING LOVE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "USADC FT. BENNING LOVE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Benning, GA

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.