| Organization Name: | 419 MEDICAL SQUADRON |
| NPI Number: | 1689691230 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT ATISME (MENTAL HEALTH THERAPIST) |
| Mailing Address: | 7311 11th St Hill Afb |
| State: | UT US |
| Postal Code: | 840565012 |
| Phone Number: | 8017772622 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 06/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 276400000X |
| License Number: | 06477 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Hospital Units |
| Taxonomy Classification: | Rehabilitation, Substance Use Disorder Unit |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoactive substance use disorders (commonly referred to as alcohol and drug abuse or substance abuse.) |