Organization
316TH MEDGRP-MALCOLM GROW
Active
Parent organization
316TH MEDGRP-MALCOLM GROW
Other names
779th Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
316TH MEDGRP-MALCOLM GROW
Authorized official
WILLIAM MICHAEL CONDON (DHA FINANCIAL MANAGER)
(240) 401-3643
Entity
Organization
Contact information
Practice address
1060 W PERIMETER RD, JB ANDREWS, MD 20762-6602
(240) 857-8658
(240) 857-7700
Mailing address
1060 W PERIMETER RD, JB ANDREWS, MD 20762-6602
(240) 857-8658
(240) 857-7700
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
Primary
—
—
Other
Enumeration date
04/28/2006
Last updated
03/12/2025
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