Provider Demographics
NPI:1235355322
Name:37TH MEDICAL GROUP
Entity Type:Organization
Organization Name:37TH MEDICAL GROUP
Other - Org Name:37TH MEDICAL GROUP - LACKLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANSKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-588-6419
Mailing Address - Street 1:2506 BIGGS AVENUE
Mailing Address - Street 2:BLDG. 2506
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5511
Mailing Address - Country:US
Mailing Address - Phone:210-671-9421
Mailing Address - Fax:210-925-1127
Practice Address - Street 1:2506 BIGGS AVENUE
Practice Address - Street 2:BLDG. 2506
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5511
Practice Address - Country:US
Practice Address - Phone:210-671-9421
Practice Address - Fax:210-925-1127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILFORD HALL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure