Provider Demographics
NPI:1396972238
Name:UNITED STATES AIR FORCE
Entity type:Organization
Organization Name:UNITED STATES AIR FORCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDANT DUTY MEDICAL TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:OCTAVIO
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-856-9968
Mailing Address - Street 1:2305 SAXONY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:310-856-9968
Mailing Address - Fax:
Practice Address - Street 1:PSC 3 BOX 692
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96266
Practice Address - Country:US
Practice Address - Phone:310-856-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital