Healthcare Provider Details

I. General information

NPI: 1942616057
Provider Name (Legal Business Name): 99TH MEDGRP-NELLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

MIKE OCALLAGHAN FEDERAL HOSPITAL C/O FRANCES BANTUGAN 4700 LAS VEGAS BLVD N.
NELLIS AFB NV
89191
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2747
  • Fax: 702-653-2755
Mailing address:
  • Phone: 702-653-2747
  • Fax: 702-653-2755

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