Provider Demographics
NPI:1417363482
Name:ROBINS AIR FORCE BASE 78TH MEDICAL GROUP
Entity Type:Organization
Organization Name:ROBINS AIR FORCE BASE 78TH MEDICAL GROUP
Other - Org Name:DOD ROBINS EPHCY
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:ROBINS AIR FORCE BASE 78TH MEDICAL GROUP C/O WILLIAM SA
Mailing Address - Street 2:655 7TH ST.
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:478-327-8023
Mailing Address - Fax:478-327-8170
Practice Address - Street 1:655 7TH ST BLDG 700
Practice Address - Street 2:
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-8023
Practice Address - Fax:478-327-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146771OtherPK