# 375TH MEDGRP-SCOTT

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 375TH MEDGRP-SCOTT
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1861478448
- **Legal business name:** 375TH MEDGRP-SCOTT
- **Authorized official:** DR. BRUCE JAY GARDNER II M.D. (RESIDENT PHYSICIAN)
- **Authorized official phone:** (618) 256-6267

## Contact information

- **Practice address:** 310 W LOSEY ST, SCOTT AFB, IL 62225-5250
- **Practice address phone:** (618) 256-6267
- **Practice address fax:** (618) 256-7931
- **Mailing address:** 310 W LOSEY ST, SCOTT AFB, IL 62225-5250
- **Mailing address phone:** (618) 256-6267
- **Mailing address fax:** (618) 256-7931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 286500000X | Military Hospital | — | NULL | Yes |

## Other

- **Enumeration date:** 12/15/2005
- **Last updated:** 05/29/2025