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General NPI Number Information
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NPI Number | 1285624262
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Entity Type | Organization
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Legal Business Name | 55 MDOS
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 55 MDOS SGO 2501 CAPEHART RD
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City | OFFUTT A F B
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State | NE
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Zip | 68113-1712
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Country | US
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Telephone | 402-294-7883
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Fax |
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Provider Business Mailing Address
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Address Line | 55 MDOS SGO 2501 CAPEHART RD
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City | OFFUTT A F B
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State | NE
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Zip | 68113-1712
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Country | US
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Telephone | 402-294-7883
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Fax |
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Authorized Official
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Title or Position | MENAL HEALTH FLIGHT COMMANDER
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Name | DR. STEPHEN F HAMILTON
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Credential | PHD
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Telephone | 402-294-7883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 679
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License Number State | OK
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