Organization
99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL
Active
Other names
NELLIS VA OUTPATIENT PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
MIKE O CALLAGHAN FEDERAL HOSP/SGSAP, 4700 LAS VEGAS BLVD NORTH BLDG 1300, NELLIS AFB, NV 89191
(702) 653-3201
(702) 653-2171
Mailing address
99 MDSS/SGSR 4700 N LAS VEGAS BLVD, ATTN: THIRD PARTY BILLING, LOS VEGAS, NV 89191
(702) 653-3589
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2051663
PK
—
Enumeration date
12/15/2006
Last updated
01/11/2016
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