MONCRIEF ARMY COMMUNITY HOSPITAL (NPI# 1902002462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902002462 |
| Entity Type | Organization |
| Organization Name | MONCRIEF ARMY COMMUNITY HOSPITAL |
| Other Organization Name | USADC PHY EXAM STA-JACKSON |
| Practice Address |
1890 Washington Road Fort Jackson SC 29207 |
| Mailing Address |
4500 Stuart St Box 497 Fort Jackson SC 29207-5720 |
| Practice Telephone | 8037512021 |
| Mailing Telephone | 8037510472 |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2015-04-08 |
| Authorized Official Name | WILLIE WARREN (CHIEF, UBO) |
| Authorized Official Telephone | 8037510472 |
| Is Organization Subpart | Y |
| Parent Organization Name | MONCRIEF ARMY COMMUNITY HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| USADC PHY EXAM STA-JACKSON | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669877064 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1021 Pinnacle Point Dr Ste 200, Columbia, SC 29223-5740 | 2014-10-28 |
| 1972823722 | Moncrief Army Community Hospital | Clinic/Center | 1021 Pinnancle Point, Moncrief Medical Home-jackson, Columbia, SC 29223-5740 | 2010-06-03 |
| 1376749838 | Moncrief Army Community Hospital | Clinic/Center | 5330 Mosby Street, Fort Jackson, SC 29207 | 2007-06-22 |
| 1932304946 | Moncrief Army Community Hospital | Clinic/Center | 4590 Strom Thurmond Blvd, Columbia, SC 29207-5305 | 2007-06-19 |
| 1235238411 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4500, Stuart Street, Ft Jackson, SC 29207 | 2006-09-22 |
| 1043319213 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4575, Marion Ave, Ft Jackson, SC 29207 | 2006-09-22 |
| 1881793057 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4716, Commissary Rd, Ft Jackson, SC 29207 | 2006-09-22 |
| 1194138859 | Moncrief Army Community Hospital | Pharmacy | 4500 Stuart Ave, Columbia, SC 29207-5700 | 2014-06-10 |
| 1316228448 | Moncrief Army Community Hospital | Clinic/Center | 4323 Hill St, Columbia, SC 29207-6022 | 2011-09-02 |
| 1073802807 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 4500 Stuart Ave, Columbia, SC 29207-5700 | 2011-04-01 |
| Street Address |
1890 WASHINGTON ROAD |
| City | FORT JACKSON |
| State | SC |
| Zip Code | 29207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265043756 | Steven Mariani Rodriguez | Dentist | 5330 Moseby Street, Columbia, SC 29207 | 2020-08-10 |
| 1568082493 | Nichole Eckrich | Dentist | 5330 Moseby St., Columbia, SC 29207 | 2020-04-21 |
| 1730733007 | Forrest Wane Fullenkamp | Student in an Organized Health Care Education/Training Program | 5330 Moseby St, Columbia, SC 29207 | 2019-07-25 |
| 1306401625 | Kayla Anne Wolcott | Pharmacist | Moncrief Army Hospital Outpatient Pharmacy 1 Ft Jackson, Columbia, SC 29207 | 2019-05-02 |
| 1588145098 | Renetta Denise Green | Counselor | Fort Jackson/acs 9810 Lee St, Columbia, SC 29207 | 2018-08-23 |
| 1154814028 | Amanda Zelnick | Dentist | Bldg 5330 Moseby St, Ft Jackson, NC 29207 | 2018-06-14 |
| 1790231777 | Brittaney Elizabeth Anne Lewelling | Specialist/Technologist | 5975 Chesnut Road, Columbia, SC 29207 | 2016-08-30 |
| 1376749838 | Moncrief Army Community Hospital | Clinic/Center | 5330 Mosby Street, Fort Jackson, SC 29207 | 2007-06-22 |
| 1730279860 | Donna L Briquet | Pharmacist | 4500 Marion Street, Columbia, SC 29207 | 2006-10-12 |
| 1235238411 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4500, Stuart Street, Ft Jackson, SC 29207 | 2006-09-22 |
| Find all providers in zip 29207 | ||||
| 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 |
|---|---|---|---|---|
| 1376749838 | Moncrief Army Community Hospital | Clinic/Center | 5330 Mosby Street, Fort Jackson, SC 29207 | 2007-06-22 |
| 1386652956 | Moncrief Army Community Hospital | Clinic/Center | 4500 Stuart St, Fort Jackson, SC 29207-5720 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972823722 | Moncrief Army Community Hospital | Clinic/Center | 1021 Pinnancle Point, Moncrief Medical Home-jackson, Columbia, SC 29223-5740 | 2010-06-03 |
| 1932304946 | Moncrief Army Community Hospital | Clinic/Center | 4590 Strom Thurmond Blvd, Columbia, SC 29207-5305 | 2007-06-19 |
| 1770517658 | Naval Health Clinic Charleston | Clinic/Center | 110 Nnptc Circle, Ubo/tpc, Goose Creek, SC 29445 | 2006-07-10 |
| 1629038997 | Branch Medical Clinic Parris Island | Clinic/Center | Bldg 598, Parris Island, SC 29905 | 2006-03-23 |
| 1316228448 | Moncrief Army Community Hospital | Clinic/Center | 4323 Hill St, Columbia, SC 29207-6022 | 2011-09-02 |
| 1427233048 | Raymond Glenn Smith | Clinic/Center | 1 Pinckney Blvd, Beaufort, SC 29902-6122 | 2008-01-02 |
| 1083897656 | William Daniel Sanchez Jr. | Clinic/Center | 1 Pinckney Blvd, Beaufort, SC 29902-6122 | 2007-12-06 |
| 1942406764 | Moncrief Army Community Hospital | Clinic/Center | 4500 Stuart St, Us Army Dental Clinic, Columbia, SC 29207-5700 | 2007-06-27 |
| 1942416755 | Moncrief Army Community Hospital | Clinic/Center | 4500 Stuart St, Usapec, Columbia, SC 29207-5700 | 2007-05-16 |
| 1285840512 | Moncrief Army Community Hospital | Clinic/Center | 4500 Stuart St, Bldg 4575, Columbia, SC 29207-5700 | 2007-05-15 |
| Find all providers with the same taxonomy | ||||
| City | FORT JACKSON |
| Zip Code | 29207 |
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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.