Organization
92ND MEDICAL GROUP
Active
Other names
FAIRCHILD REFILL PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
BLDG 2460, FAIRCHILD AFB, WA 99011
(509) 247-2507
(509) 247-5594
Mailing address
92ND MEDICAL GROUP, RMO OFFICE 3RD PARTY COLLECTIONS 701 HOSPITAL LOOP, FAIRCHILD AFB, WA 99011-8704
(509) 247-2507
(509) 247-5594
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2110606
PK
—
Enumeration date
09/22/2006
Last updated
06/12/2015
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