Provider Demographics
NPI:1417185935
Name:HQ AIR FORCE RESERVE COMMAND
Entity type:Organization
Organization Name:HQ AIR FORCE RESERVE COMMAND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMAND FUNCTIONAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:IDMT
Authorized Official - Phone:478-327-1893
Mailing Address - Street 1:135 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-1601
Mailing Address - Country:US
Mailing Address - Phone:478-327-1893
Mailing Address - Fax:
Practice Address - Street 1:135 PAGE RD
Practice Address - Street 2:
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-1601
Practice Address - Country:US
Practice Address - Phone:478-327-1893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure