# 21ST MEDGRP-PETERSON

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 21ST MEDGRP-PETERSON
- **Other names:** DoD PETERSON SATL ePhcy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932514171
- **Legal business name:** 21ST MEDGRP-PETERSON
- **Authorized official:** HECTOR MORALES (CHIEF DHA PASS)
- **Authorized official phone:** (210) 536-6650

## Contact information

- **Practice address:** 110 W ENT AVE, PETERSON AFB, CO 80914-1595
- **Practice address phone:** (719) 556-0865
- **Practice address fax:** (719) 556-1106
- **Mailing address:** 21ST MEDICAL GROUP C/O RMO OFFICE, 559 VINCENT ST, PETERSON AFB, CO 80914-1541
- **Mailing address phone:** (719) 556-0865
- **Mailing address fax:** (719) 556-1106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332000000X | Military/U.S. Coast Guard Pharmacy | — | NULL | Yes |
| 333600000X | Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/26/2014
- **Last updated:** 06/13/2025