Healthcare Provider Details

I. General information

NPI: 1356755185
Provider Name (Legal Business Name): 49TH MEDGRP-HOLLOMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 1ST ST BLDG 15
HOLLOMAN AFB NM
88330-8273
US

IV. Provider business mailing address

49TH MEDICAL GROUP BALDWIN HERMAN S II 280 1ST STREET
HOLLOMAN AFB NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-0524
  • Fax: 575-572-5781
Mailing address:
  • Phone: 575-572-0524
  • Fax: 575-572-5781

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