Provider Demographics
NPI:1053726992
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:C/O WINN-THIRD PARTY INSURANCE
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6147
Mailing Address - Fax:912-767-8786
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-6040
Practice Address - Fax:912-435-5062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACH WINN-FT STEWART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-30
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146593OtherPK