Organization Name: | 82 MEDICAL GROUP |
NPI Number: | 1851376248 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SERENA LYNN HANSKEN (AIR FORCE UNIFORM BUSINESS OFFICE) |
Mailing Address: | 149 Hart St Ste 1 Sheppard Afb |
State: | TX US |
Postal Code: | 763113478 |
Phone Number: | 9406763388 |
Fax Number: | |
NPI Enumeration Date: | 12/08/2005 |
NPI Last Update Date: | 11/19/2010 |
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 |