Provider Demographics
NPI:1174656573
Name:421 MEDICAL CENTER
Entity Type:Organization
Organization Name:421 MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AIR FORCE UNIFORM BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-681-6303
Mailing Address - Street 1:BUILDING 26
Mailing Address - Street 2:MEDICAL CENTER
Mailing Address - City:RAF MENWITH HILL
Mailing Address - State:HARROGATE
Mailing Address - Zip Code:HG3 2RF
Mailing Address - Country:GB
Mailing Address - Phone:0142-377-7229
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 26
Practice Address - Street 2:MEDICAL CENTER
Practice Address - City:RAF MENWITH HILL
Practice Address - State:HARROGATE
Practice Address - Zip Code:HG3 2RF
Practice Address - Country:GB
Practice Address - Phone:0142-377-7229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1710973029261QM1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1103XAmbulatory Health Care FacilitiesClinic/CenterMilitary Ambulatory Procedure Visits Operational (Transportable)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1710973029OtherMEDICAL PHYSICIAN SURGEON