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General NPI Number Information
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NPI Number | 1104231091
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Entity Type | Organization
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Legal Business Name | 319TH MEDGRP-GRAND FORKS
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 1599 J ST
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City | GRAND FORKS AFB
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State | ND
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Zip | 58205-6306
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Country | US
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Telephone | 701-747-5382
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Fax | 701-747-5384
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Provider Business Mailing Address
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Address Line | 319TH MEDICAL GROUP 3RD PARTY COLLECTIONS 1599 J. STREET
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City | GRAND FORKS AB
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State | ND
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Zip | 58205-6306
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Country | US
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Telephone | 701-747-5382
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Fax | 701-747-5384
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Authorized Official
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Title or Position | CHIEF DHA PASS
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Name | HECTOR MORALES
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Credential |
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Telephone | 210-536-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332000000X
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Taxonomy Name | Military/U.S. Coast Guard Pharmacy
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License Number |
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License Number State |
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