MEDICARE: 37TH MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1101X	Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
2	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1235355322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	37TH MEDICAL GROUP

Provider Business Mailing Address
First Line	:	2506 BIGGS AVENUE
Second Line	:	BLDG. 2506
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-671-9421
Fax Number	:	210-925-1127

Provider Business Practice Location Address
First Line	:	2506 BIGGS AVENUE
Second Line	:	BLDG. 2506
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-671-9421
Fax Number	:	210-925-1127

Authorized Official
Title or Position	:	BUSINESS OFFICE PROGRAM MANAGER
Name	:	SERENA LYNN HANSKEN
Credential	:
Telephone Number	:	703-588-6419

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	11/15/2010

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Directions to “37TH MEDICAL GROUP ” Practice Location

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