Healthcare Provider Details

I. General information

NPI: 1871909846
Provider Name (Legal Business Name): 55TH MEDGRP-OFFUTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 CUSTER DR
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

EHRLING BERQUIST HOSPITAL 2501 CAPEHART RD
OFFUTT AFB NE
68113
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-3228
  • Fax: 402-294-0711
Mailing address:
  • Phone: 402-294-3270
  • Fax: 402-294-0711

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