Provider Demographics
NPI:1417745431
Name:USAFA
Entity type:Organization
Organization Name:USAFA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOOTBALL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LODGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:719-333-2416
Mailing Address - Street 1:2168 FIELD HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-9599
Mailing Address - Country:US
Mailing Address - Phone:412-862-6521
Mailing Address - Fax:
Practice Address - Street 1:2168 FIELD HOUSE DR
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-9599
Practice Address - Country:US
Practice Address - Phone:412-862-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports DieteticsGroup - Single Specialty