Provider Demographics
NPI:1891247706
Name:AIR FORCE
Entity Type:Organization
Organization Name:AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IDMT
Authorized Official - Prefix:
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-589-6025
Mailing Address - Street 1:690 BARNES BLVD
Mailing Address - Street 2:
Mailing Address - City:MCCHORD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:98438-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 BARNES BLVD
Practice Address - Street 2:
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98438-0000
Practice Address - Country:US
Practice Address - Phone:253-982-5688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical TechniciansGroup - Multi-Specialty