Provider Demographics
NPI:1568437234
Name:AIR FORCE MEDICAL OPERATIONS AGENCY
Entity Type:Organization
Organization Name:AIR FORCE MEDICAL OPERATIONS AGENCY
Other - Org Name:AFMOA
Other - Org Type:Other Name
Authorized Official - Title/Position:SGOC
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-404-7361
Mailing Address - Street 1:525 FRAIM STREET
Mailing Address - Street 2:AFMOA/SGXS
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-619-7504
Mailing Address - Fax:301-619-2417
Practice Address - Street 1:525 FRAIM STREET
Practice Address - Street 2:AFMOA/SGXS
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-619-7504
Practice Address - Fax:301-619-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital