Healthcare Provider Details

I. General information

NPI: 1952716847
Provider Name (Legal Business Name): 22D MEDGRP-MCCONNELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57950 LEAVENWORTH ST BLDG 250
MCCONNELL AFB KS
67221-3505
US

IV. Provider business mailing address

22ND MEDICAL GROUP 57950 LEAVENWORTH ST. 6E4
MCCONNELL AFB KS
67221-3506
US

V. Phone/Fax

Practice location:
  • Phone: 316-759-5277
  • Fax: 630-570-6062
Mailing address:
  • Phone: 316-759-5277
  • Fax: 316-759-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
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