Provider Demographics
NPI:1417356072
Name:27TH MEDICAL GROUP
Entity type:Organization
Organization Name:27TH 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 1:27TH MEDICAL GROUP SGSL
Mailing Address - Street 2:208 W. D.L. INGRAM BLVD. 1ST FLOOR
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:575-784-4028
Mailing Address - Fax:575-784-7494
Practice Address - Street 1:224 WEST D. L. INGRAM BLVD
Practice Address - Street 2:BLDG 1408
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5103
Practice Address - Country:US
Practice Address - Phone:575-784-4912
Practice Address - Fax:575-784-7494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:27TH MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-20
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147336OtherPK