| Organization Name: | MAXWELL AFB AMBULATORY HEALTH CARE CENTER |
| NPI Number: | 1396738944 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TOMEKA DANIELLE RUSSELL (FAMILY PRACTICE PHYSICIAN) |
| Mailing Address: | 300 S. Twining Street Bldg 760, Family Practice - Yellow Team Maxwell Afb |
| State: | AL US |
| Postal Code: | 36112 |
| Phone Number: | 3349532234 |
| Fax Number: | |
| NPI Enumeration Date: | 08/30/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1100X |
| License Number: | 25934 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| 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 |