Provider Demographics
NPI:1104231091
Name:319TH MEDICAL GROUP
Entity type:Organization
Organization Name:319TH MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:319TH MEDICAL GROUP
Mailing Address - Street 2:3RD PARTY COLLECTIONS 1599 J. STREET
Mailing Address - City:GRAND FORKS AB
Mailing Address - State:ND
Mailing Address - Zip Code:58205-6306
Mailing Address - Country:US
Mailing Address - Phone:701-747-5382
Mailing Address - Fax:701-747-5384
Practice Address - Street 1:1599 J ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58205-6306
Practice Address - Country:US
Practice Address - Phone:701-747-5382
Practice Address - Fax:701-747-5384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146293OtherPK