Healthcare Provider Details

I. General information

NPI: 1750488508
Provider Name (Legal Business Name): 10TH MEDICAL GROUP SGSL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8119 PARK DR
USAF ACADEMY CO
80840-2397
US

IV. Provider business mailing address

8119 PARK DR
USAF ACADEMY CO
80840-2397
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-0545
  • Fax: 719-333-0544
Mailing address:
  • Phone: 719-333-0545
  • Fax: 719-333-0544

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