MEDICARE: 51 MDOS

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	261Q00000X	Clinic/Center		AZ

General Provider Information

NPI Number	:	1770556284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	51 MDOS

Provider Business Mailing Address
First Line	:	2353 N 123RD DR
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-6500
Country	:	US
Telephone Number	:	623-535-8432
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 MDOS
Second Line	:	PSC 3 BOX 2652
City	:	APO
State	:	AP
Zip	:	96266
Country	:	KR
Telephone Number	:	315-874-7473
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	JAMES LAMUNYON
Credential	:	PA-CERTIFIED
Telephone Number	:	315-784-7473

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	08/22/2020

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Directions to “51 MDOS ” Practice Location

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