Provider Demographics
NPI:1053616912
Name:ACH WINN-FT STEWART
Entity type:Organization
Organization Name:ACH WINN-FT STEWART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:1061 HARMON AVE STE ID03
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:210-221-8274
Mailing Address - Fax:210-295-2567
Practice Address - Street 1:1061 HARMON AVE STE ID03
Practice Address - Street 2:C/O WINN THIRD PARTY INSURANCE
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:210-221-8274
Practice Address - Fax:210-295-2567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACH WINN-FT STEWART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-24
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128535OtherPK