Provider Demographics
NPI:1982010955
Name:10TH MEDICAL GROUP - USAFA
Entity Type:Organization
Organization Name:10TH MEDICAL GROUP - USAFA
Other - Org Name:DOD USAFA COMMUNITY EPHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:USAFA 10TH MEDICAL GROUP/SGSBR
Mailing Address - Street 2:4102 PINION DR. SUITE 100
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840
Mailing Address - Country:US
Mailing Address - Phone:719-333-0545
Mailing Address - Fax:719-333-0544
Practice Address - Street 1:8118 PARK DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2397
Practice Address - Country:US
Practice Address - Phone:719-333-9801
Practice Address - Fax:719-333-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146772OtherPK