Healthcare Provider Details

I. General information

NPI: 1891982518
Provider Name (Legal Business Name): JTF-B MED EL-HONDURAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5700
APO AA
34042
US

IV. Provider business mailing address

UNIT 5700
APO AA
34042
US

V. Phone/Fax

Practice location:
  • Phone: 0115042348641
  • Fax:
Mailing address:
  • Phone: 0115042348641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JO-EL ONSTAD
Title or Position: HQ MEDCOM UBO
Credential:
Phone: 210-221-8567