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Organization

62D MEDICAL GROUP USAF

Active
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
690 A ST, MCCHORD AFB, WA 98438-1303
(253) 982-5586
(253) 982-5978
Mailing address
690 A ST, MCCHORD AFB, WA 98438-1303
(253) 982-5586
(253) 982-5978

Taxonomy

Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
332000000X
Military/U.S. Coast Guard Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
49-27197
NCPDP
WA
Enumeration date
03/27/2006
Last updated
11/12/2010
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