Provider Demographics
NPI:1780657239
Name:10TH MEDICAL GROUP - USAFA
Entity Type:Organization
Organization Name:10TH MEDICAL GROUP - USAFA
Other - Org Name:USAFA MTF
Other - Org Type:Other Name
Authorized Official - Title/Position:AIR FORCE UNIFORM BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RIDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-681-6384
Mailing Address - Street 1:4102 PINION DR
Mailing Address - Street 2:10 MDSS SGSB
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5648
Mailing Address - Fax:719-333-5202
Practice Address - Street 1:4102 PINION DR
Practice Address - Street 2:10 MDSS SGSB
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5648
Practice Address - Fax:719-333-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No286500000XHospitalsMilitary Hospital
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0616536OtherNCPDP