Provider Demographics
NPI:1346211059
Name:U. S. COAST GUARD
Entity Type:Organization
Organization Name:U. S. COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FLIGHT SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-966-5537
Mailing Address - Street 1:COMDT (CG-1122)
Mailing Address - Street 2:2100 2ND ST SW ROOM 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:907-966-5438
Mailing Address - Fax:907-966-5491
Practice Address - Street 1:611 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9436
Practice Address - Country:US
Practice Address - Phone:907-966-5438
Practice Address - Fax:907-966-5491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC261QM1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient