Healthcare Provider Details

I. General information

NPI: 1912133786
Provider Name (Legal Business Name): UNITED STATES AIR FORCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2009
Last Update Date: 06/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 COYOTE RUN
ABILENE TX
79602-8185
US

IV. Provider business mailing address

4810 COYOTE RUN
ABILENE TX
79602-8185
US

V. Phone/Fax

Practice location:
  • Phone: 325-965-5490
  • Fax:
Mailing address:
  • Phone: 325-965-5490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: SARA HAY
Title or Position: INDEPENDENT DUTY MEDICAL TECHNICIAN
Credential:
Phone: 325-965-5490