| Organization Name: | HICKAM AFB 15TH MDG |
| NPI Number: | 1952582009 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MERCEDES HAMILTON (REFERRAL MANAGER) |
| Mailing Address: | 755 Scott Cir 15th Med Group Hickam Afb |
| State: | HI US |
| Postal Code: | 968535399 |
| Phone Number: | 8084486133 |
| Fax Number: | |
| NPI Enumeration Date: | 11/16/2007 |
| NPI Last Update Date: | 11/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 14816 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |