| Organization Name: | 55 MDOS |
| NPI Number: | 1881095669 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAMA BHYRAVABHOTLA (DIRECTOR IPAP PHASE 2 PROGRAM) |
| Mailing Address: | 2501 Capehart Rd Offutt Afb |
| State: | NE US |
| Postal Code: | 681131043 |
| Phone Number: | 4022328046 |
| Fax Number: | |
| NPI Enumeration Date: | 09/11/2014 |
| NPI Last Update Date: | 02/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |