Healthcare Provider Details

I. General information

NPI: 1023172772
Provider Name (Legal Business Name): 27TH MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W CASABLANCA AVE BLDG 1400
CANNON AFB NM
88103
US

IV. Provider business mailing address

208 W CASABLANCA AVE BLDG 1400
CANNON AFB NM
88103
US

V. Phone/Fax

Practice location:
  • Phone: 505-784-4028
  • Fax: 505-784-4222
Mailing address:
  • Phone: 505-784-4028
  • Fax: 505-784-4222

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: PHARMACY OPERATIONS CENTER MGR
Credential:
Phone: 210-221-8443