| Organization Name: | 42D MEDICAL GROUP |
| NPI Number: | 1033196878 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Mailing Address: | 300 South Twining St Building 760 Maxwell Afb |
| State: | AL US |
| Postal Code: | 361126219 |
| Phone Number: | 3349534943 |
| Fax Number: | 3349531741 |
| NPI Enumeration Date: | 12/22/2005 |
| NPI Last Update Date: | 03/03/2014 |
| 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 |