Healthcare Provider Details

I. General information

NPI: 1396181533
Provider Name (Legal Business Name): 341ST MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 MDG/MDSS/SGSA 7300 N PERIMETER RD BLDG 2040
MALSTROM AFB MT
59402
US

IV. Provider business mailing address

341 MDG/MDSS/SGSA 7300 N PERIMETER RD BLDG 2040
MALSTROM AFB MT
59402
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-2468
  • Fax:
Mailing address:
  • Phone: 406-731-2468
  • Fax:

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: DEPUTY DIRECTOR PHCY OPS CTR
Credential:
Phone: 210-221-8443