Provider Demographics
NPI:1316016496
Name:31ST MEDICAL GROUP SGSL
Entity Type:Organization
Organization Name:31ST MEDICAL GROUP SGSL
Other - Org Name:AVIANO MAIN PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:BLDG 121
Mailing Address - Street 2:AVIANO AB ITALY
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09604-0245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 121
Practice Address - Street 2:AVIANO AB ITALY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09604-0245
Practice Address - Country:US
Practice Address - Phone:210-536-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113916OtherPK