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General NPI Number Information
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NPI Number | 1023302957
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Entity Type | Organization
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Legal Business Name | 81ST MEDICAL GROUP
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 301 FISHER ST 81 MDOS SGOF
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City | KEESLER AFB
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State | MS
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Zip | 39534-2508
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Country | US
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Telephone | 228-376-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 301 FISHER ST 81 MDOS SGOF
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City | KEESLER AFB
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State | MS
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Zip | 39534-2508
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Country | US
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Telephone | 228-376-0440
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISSTANT
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Name | LARAMIE JAY RICHMOND
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Credential |
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Telephone | 228-376-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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