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General NPI Number Information
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NPI Number | 1285012922
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Entity Type | Organization
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Legal Business Name | 21ST MEDICAL GROUP
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 220 FALCON PKWY BLDG 220
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City | COLORADO SPRINGS
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State | CO
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Zip | 80912-5005
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Country | US
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Telephone | 719-567-4423
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Fax | 719-567-4817
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Provider Business Mailing Address
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Address Line | 21ST MEDICAL GROUP C/O RMO OFFICE 559 VINCENT ST
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City | PETERSON AFB
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State | CO
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Zip | 80914-1541
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Country | US
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Telephone |
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Fax |
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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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