Provider Demographics
NPI:1427041441
Name:USAF
Entity Type:Organization
Organization Name:USAF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:SHERIDAN
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:210-393-2465
Mailing Address - Street 1:728 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-6161
Mailing Address - Country:US
Mailing Address - Phone:210-393-2465
Mailing Address - Fax:
Practice Address - Street 1:BLD 760 MAXWELL AFB CLINIC
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-953-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10682012865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital