Provider Demographics
NPI:1740261122
Name:99TH MEDICAL GROUP, NELLIS AFB
Entity type:Organization
Organization Name:99TH MEDICAL GROUP, NELLIS AFB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF MEDICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARKHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-653-2000
Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:MIKE O'CALLAGHAN FEDERAL HOSPITAL
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-2616
Mailing Address - Fax:
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:MIKE O'CALLAGHAN FEDERAL HOSPITAL
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-653-2616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty