Healthcare Provider Details

I. General information

NPI: 1619074465
Provider Name (Legal Business Name): 341ST MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N PERIMETER RD
MALMSTROM AFB MT
59402-6701
US

IV. Provider business mailing address

341ST MEDICAL GROUP-UNITED STATES AIR FORCE 7300 N PERIMETER RD
MALMSTROM AFB MT
59402
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-2900
  • Fax: 406-731-4364
Mailing address:
  • Phone: 406-731-2900
  • Fax: 406-731-4364

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