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NPI Code Detail

MEDICARE: 99TH MEDICAL GROUP, NELLIS AFB

MEDICARE: 99TH MEDICAL GROUP, NELLIS AFB
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
11223G0001XGeneral Practice Dentistry5434KY

General Provider Information

NPI Number : 1740261122
Entity Type Code : Organization
Provider Name (Legal Business Name) : 99TH MEDICAL GROUP, NELLIS AFB
Provider Business Mailing Address
First Line : 4700 LAS VEGAS BLVD N
Second Line : MIKE O'CALLAGHAN FEDERAL HOSPITAL
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2616
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line : MIKE O'CALLAGHAN FEDERAL HOSPITAL
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2616
Fax Number :
Authorized Official
Title or Position : CHIEF OF MEDICAL SERVICES
Name : DR. MARKHAM BROWN
Credential : MD
Telephone Number : 702-653-2000
Provider Enumeration Date : 11/10/2005
Last Update Date : 06/13/2008

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