# 316TH MEDGRP-MALCOLM GROW

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 316TH MEDGRP-MALCOLM GROW
- **Other names:** 779th Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1215994660
- **Legal business name:** 316TH MEDGRP-MALCOLM GROW
- **Authorized official:** WILLIAM MICHAEL CONDON (DHA FINANCIAL MANAGER)
- **Authorized official phone:** (240) 401-3643

## Contact information

- **Practice address:** 1060 W PERIMETER RD, JB ANDREWS, MD 20762-6602
- **Practice address phone:** (240) 857-8658
- **Practice address fax:** (240) 857-7700
- **Mailing address:** 1060 W PERIMETER RD, JB ANDREWS, MD 20762-6602
- **Mailing address phone:** (240) 857-8658
- **Mailing address fax:** (240) 857-7700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | NULL | — |
| 261QM1101X | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/28/2006
- **Last updated:** 03/12/2025