Healthcare Provider Details

I. General information

NPI: 1619381415
Provider Name (Legal Business Name): 81ST MEDGRP-KEESLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LARCHER BLVD STE B
KEESLER AFB MS
39534-2342
US

IV. Provider business mailing address

DEPARTMENT OF AIR FORCE 81ST MEDICAL GROUP 301 FISHER ST. STE 104
KEESLER AFB MS
39534-2517
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-6585
  • Fax: 228-376-0058
Mailing address:
  • Phone: 228-376-0058
  • Fax: 228-377-6582

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