Provider Demographics
NPI:1861477176
Name:USAF ACTIVE DUTY
Entity Type:Organization
Organization Name:USAF ACTIVE DUTY
Other - Org Name:RAF LAKENHEATH OR 48TH MED GRP
Other - Org Type:Other Name
Authorized Official - Title/Position:AIR FORCE UNIFORM BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANSKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-588-6419
Mailing Address - Street 1:BOX 230
Mailing Address - Street 2:UNIT 5210
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464-5210
Mailing Address - Country:US
Mailing Address - Phone:0163-852-8703
Mailing Address - Fax:
Practice Address - Street 1:48TH MEDICAL GRP RAF LAKENHEATH
Practice Address - Street 2:UNIT 5210
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464-5210
Practice Address - Country:US
Practice Address - Phone:0163-852-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy