Provider Demographics
NPI:1154545440
Name:UNITED STATES AIR FORCE
Entity type:Organization
Organization Name:UNITED STATES AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC RESIDENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WOODSON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-292-7520
Mailing Address - Street 1:918 DILLONS VIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4339
Mailing Address - Country:US
Mailing Address - Phone:210-681-0797
Mailing Address - Fax:
Practice Address - Street 1:WILFORD HALL MEDICAL CENTER
Practice Address - Street 2:2200 BERGQUIST DRIVE
Practice Address - City:LACKLAND AIR FORCE BASE
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-292-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty