Provider Demographics
NPI:1316604739
Name:USCG AIRSTA SAVANNAH MEDICAL CLINIC
Entity type:Organization
Organization Name:USCG AIRSTA SAVANNAH MEDICAL CLINIC
Other - Org Name:
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 1:1297 N LIGHTNING RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31409-4703
Mailing Address - Country:US
Mailing Address - Phone:912-201-2697
Mailing Address - Fax:912-652-4191
Practice Address - Street 1:1297 N LIGHTNING RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-4703
Practice Address - Country:US
Practice Address - Phone:912-201-2697
Practice Address - Fax:912-652-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy