| Organization Name: | MALCOLM GROW MEDICAL CENTER |
| NPI Number: | 1215994660 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA M. MITCHELL (AIR FORCE UBO ANALYST) |
| Mailing Address: | 1050 W Perimeter Rd Mdss Sgsr Andrews Afb |
| State: | MD US |
| Postal Code: | 207626600 |
| Phone Number: | 2408578658 |
| Fax Number: | 2408577700 |
| NPI Enumeration Date: | 04/28/2006 |
| NPI Last Update Date: | 05/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military/U.S. Coast Guard Outpatient |
| Taxonomy Definition: | The Defense Health Program or U.S. Coast Guard funded |