Organization
92ND MEDICAL GROUP
Active
Other names
FAIRCHID SCM PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
103 SAATZ RD, FAIRCHILD AFB, WA 99011
(509) 247-5567
(509) 247-2021
Mailing address
92RD MEDICAL GROUP, RMO OFFICE 3RD PARTY COLLECTIONS 701 HOSPITAL LOOP, FAIRCHILD AFB, WA 99011-8704
(509) 247-5567
(509) 247-2021
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134472
PK
—
Enumeration date
03/29/2012
Last updated
06/12/2015
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