Healthcare Provider Details

I. General information

NPI: 1801201793
Provider Name (Legal Business Name): 5TH MEDGRP-MINOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 MISSILE AVE
MINOT AFB ND
58705-5008
US

IV. Provider business mailing address

5TH MEDICAL GROUP 10 MISSILE AVE.
MINOT AFB ND
58705
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5293
  • Fax: 701-723-5302
Mailing address:
  • Phone: 701-723-5293
  • Fax: 701-723-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650