MEDICARE: WILLFORD HALL MEDICAL CTR

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	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2093037	OTHER		PK

General Provider Information

NPI Number	:	1295834448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLFORD HALL MEDICAL CTR

Provider Business Mailing Address
First Line	:	2200 BERGQUIST DR STE 1
Second Line	:	BLDG 4450
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-292-7970
Fax Number	:	210-292-3722

Provider Business Practice Location Address
First Line	:	2200 BERGQUIST DR STE 1
Second Line	:	BLDG 4450
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-292-7970
Fax Number	:	210-292-3722

Authorized Official
Title or Position	:	CHIEF DHA PASS
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-536-6650

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/25/2016

Similar Medicare Providers

1427041979 — DR. TERENCE GERALD BENSON JR. PHARMD
Practice Location Address:

2200 BERGQUIST DR STE 1
LACKLAND AFB, TX
78236-9908

Practice Phone: 210-292-4645
Practice Fax:

1851385678 — DR. DAVID STOCKTON NOLL D.O.
Practice Location Address:

59TH ORTHOPEDIC AND REHAB SQUADRON , 2200 BERGQUIST DR STE 1
LACKLAND AFB, TX
78236-9908

Practice Phone: 210-292-5044
Practice Fax:

1487640785 — DR. CHANTAL COUSINEAU-KRIEGER M.D.
Practice Location Address:

59TH MEDICAL WINGE GE , 2200 BERGQUIST DRIVE STE 1
LACKLAND AFB, TX
78236-9908

Practice Phone: 240-505-2613
Practice Fax:

1700857612 — DR. ELIZABETH ANN HERON PHD
Practice Location Address:

2200 BERGQUIST DR STE 1
LACKLAND AFB, TX
78236-9908

Practice Phone: 210-671-2032
Practice Fax:

1073576591 — DR. JON JASON O'PRY M.D.
Practice Location Address:

WILFORD HALL AMBULATORY SURGICAL CENTER , 1100 WILFORD HALL LOOP, BLDG 4554
JBSA-LACKLAND AFB, TX
78236-9908

Practice Phone: 210-292-6376
Practice Fax:

1629032867 — MRS. PHYLLIS GALLEGOS SANTILLAN MS, CCC-SLP
Practice Location Address:

1100 WILFORD HALL LOOP , BLDG. 4554
JBSA-LACKLAND AFB, TX
78236-9908

Practice Phone: 210-292-5420
Practice Fax: 210-292-4527

Directions to “WILLFORD HALL MEDICAL CTR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.