Organization
27TH MEDICAL GROUP
Active
Parent organization
27TH MEDICAL GROUP
Other names
CANNON MAIN PHCY
Organization subpart
Yes
Provider details
NPI number
Legal business name
27TH MEDICAL GROUP
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
208 W CASABLANCA AVE BLDG 1400, CANNON AFB, NM 88103-5009
(575) 784-4028
Mailing address
208 W CASABLANCA AVE BLDG 1400, CANNON AFB, NM 88103-5009
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2058697
PK
—
Enumeration date
09/22/2006
Last updated
11/08/2024
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