Organization
UNITED STATES AIR FORCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BARBOUR (CREDENTIALS)
(937) 257-1942
Entity
Organization
Contact information
Practice address
4881 SUGAR MAPLE DR, 88 MDG/MDOS, WRIGHT PATTERSON AFB, OH 45433-5546
(937) 257-4439
Mailing address
4881 SUGAR MAPLE DR, 88 MDG/MDOS, WRIGHT PATTERSON AFB, OH 45433-5546
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
4301405356
MI
Other
Enumeration date
01/12/2006
Last updated
08/22/2020
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