Provider Demographics
NPI:1174500961
Name:USAF
Entity Type:Organization
Organization Name:USAF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL GROUP COMMANDER
Authorized Official - Prefix:
Authorized Official - First Name:KORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-764-6969
Mailing Address - Street 1:1ST MEDICAL GROUP
Mailing Address - Street 2:45 PINE ROAD
Mailing Address - City:LANGLEY AFB
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2080
Mailing Address - Country:US
Mailing Address - Phone:757-764-7611
Mailing Address - Fax:
Practice Address - Street 1:1ST MEDICAL GROUP
Practice Address - Street 2:45 PINE ROAD
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-2080
Practice Address - Country:US
Practice Address - Phone:757-764-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014623286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital