Provider Demographics
NPI:1619145455
Name:US AIR FORCE
Entity Type:Organization
Organization Name:US AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMLIY PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:CASSAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-373-9947
Mailing Address - Street 1:831 W 1280 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-6518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:831 W 1280 S
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-6518
Practice Address - Country:US
Practice Address - Phone:801-373-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT590260-1205286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital