Healthcare Provider Details

I. General information

NPI: 1043627631
Provider Name (Legal Business Name): 56TH MEDGRP-LUKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD BLDG 1130
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

56TH MEDICAL GROUP C/O JAME MITCHELL 7219 N. LITCHFIELD RD.
LUKE AFB AZ
85309
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-3934
  • Fax: 623-856-3616
Mailing address:
  • Phone: 623-856-3934
  • Fax: 623-856-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650