Provider Demographics
NPI:1952532814
Name:UNITED STATES AIR FORCE
Entity Type:Organization
Organization Name:UNITED STATES AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IDMT/SSGT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-404-1142
Mailing Address - Street 1:4250 GRIFFISS AVE
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191-7018
Mailing Address - Country:US
Mailing Address - Phone:702-404-1142
Mailing Address - Fax:
Practice Address - Street 1:4250 GRIFFISS AVE
Practice Address - Street 2:
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191-7018
Practice Address - Country:US
Practice Address - Phone:702-404-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical TechniciansGroup - Multi-Specialty