| Organization Name: | 509TH MEDICAL GROUP-SGSR |
| NPI Number: | 1033196480 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Mailing Address: | 331 Sijan Ave 509 Mdss Sgsr Whiteman Afb |
| State: | MO US |
| Postal Code: | 653051269 |
| Phone Number: | 6606871838 |
| Fax Number: | 6606875121 |
| NPI Enumeration Date: | 12/28/2005 |
| NPI Last Update Date: | 02/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1101X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military and U.S. Coast Guard Ambulatory Procedure |
| Taxonomy Definition: | That part of a |