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Organization
12TH MEDICAL GROUP RANDOLPH
Active
Organization
12TH MEDICAL GROUP RANDOLPH
Active
Other names
Randolph AFB Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SERENA LYNN HANSKEN (AIR FORCE UNIFORM BUSINESS OFFICE)
(703) 588-6419
Entity
Organization
Contact information
Practice address
221 3RD ST W, BLDG 1040, RANDOLPH A F B, TX 78150-4800
(210) 652-2420
(210) 652-6571
Mailing address
221 3RD ST W, BLDG 1040, RANDOLPH A F B, TX 78150-4800
(210) 652-2420
(210) 652-6571
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
NULL
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
NULL
332000000X
Military/U.S. Coast Guard Pharmacy
—
NULL
Other
Enumeration date
02/15/2006
Last updated
11/15/2010
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