Healthcare Provider Details

I. General information

NPI: 1881009033
Provider Name (Legal Business Name): 20TH MEDGRP-SHAW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MEADOWLARK ST
SHAW AFB SC
29152-5019
US

IV. Provider business mailing address

20TH MEDICAL SUPPORT SQUADRON US AIR FORCE HOSPITAL 431 MEADOWLARK ST
SHAW AFB SC
29152
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-1309
  • Fax: 803-895-6463
Mailing address:
  • Phone: 803-895-1309
  • Fax: 803-895-6463

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