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Organization
43RD MEDICAL GROUP
Active
Organization
43RD MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERENA LYNN HANSKEN (AIR FORCE UNIFORM BUSINESS OFFICE P)
(703) 588-6419
Entity
Organization
Contact information
Practice address
383 MAYNARD ST, 43RD MEDICAL GROUP, POPE AFB, NC 28308-2321
(910) 394-2205
(910) 394-2077
Mailing address
383 MAYNARD ST, 43RD MEDICAL GROUP, POPE AFB, NC 28308-2321
(910) 394-2205
(910) 394-2077
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
01/18/2006
Last updated
11/12/2010
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