| Organization Name: | 22 MEDICAL GROUP |
| NPI Number: | 1700846813 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Mailing Address: | 57950 Leavenworth St 6e4 Mcconnell Afb |
| State: | KS US |
| Postal Code: | 672213506 |
| Phone Number: | 3167595000 |
| Fax Number: | 3167595038 |
| NPI Enumeration Date: | 03/23/2006 |
| NPI Last Update Date: | 02/18/2014 |
| 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 |