Healthcare Provider Details

I. General information

NPI: 1588040224
Provider Name (Legal Business Name): 48TH MEDICAL GROUP, RAFL, USAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHESTER STREET, LAKENHEATH
BRANDON UNITED KINGDOM
IPS7 9PS
GB

IV. Provider business mailing address

CHESTER STREET, LAKENHEATH
BRANDON UNITED KINGDOM
IPS7 9PS
GB

V. Phone/Fax

Practice location:
  • Phone: 163-852-8659
  • Fax:
Mailing address:
  • Phone: 163-852-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291900000X
TaxonomyMilitary Clinical Medical Laboratory
License Number12487
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number12487
License Number StateCA

VIII. Authorized Official

Name: DR. PAMELA SMITH
Title or Position: HOSPITAL COMMANDER
Credential: M.D.
Phone: 163-852-8001