Organization · NPI-2
17th Medical Group
Clinic/Center, Health Services · Goodfellow Afb, TX
NPI number1235490574
StatusActive
Last updated in NPPESJun 4, 2012
Details
- NPI
- 1235490574
- Entity type
- Organization (NPI-2)
- Legal business name
- 17th Medical Group
- Organization subpart
- No
- Enumeration date
- Jun 4, 2012
- Last updated
- Jun 4, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QH0100X | Clinic/Center, Health Services | – | – | Yes |
Practice location
271 Fort Richardson AveGoodfellow Afb, TX 76908-4901
Phone 325-654-5238
Mailing address
1407 Gregory DrSan Angelo, TX 76905-4213
Authorized official
James Forrest
Colonel
3256543075
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