Healthcare Provider Details

I. General information

NPI: 1063738680
Provider Name (Legal Business Name): UNITED STATES AIR FORCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 6180 BOX 245
APO AE
09601-0245
US

IV. Provider business mailing address

PSC 103 BOX 5332
APO AE
09603-0054
US

V. Phone/Fax

Practice location:
  • Phone: 011390434305038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberR156952
License Number StateMD

VIII. Authorized Official

Name: VIRGINIA GARNER
Title or Position: 31ST SURGICAL SQUADRON COMMANDER
Credential:
Phone: 43-430-5038