Provider Demographics
| NPI: | 1487624466 |
|---|---|
| Name: | 65 MEDICAL GROUP |
| Entity type: | Organization |
| Organization Name: | 65 MEDICAL GROUP |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | AIR FORCE UNIFORM BUSINESS OFFICE P |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CHRISTOPHER |
| Authorized Official - Middle Name: | DOUGLAS |
| Authorized Official - Last Name: | EATON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 703-681-6303 |
| Mailing Address - Street 1: | UNIT 7745 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | APO |
| Mailing Address - State: | AE |
| Mailing Address - Zip Code: | 09720 |
| Mailing Address - Country: | PT |
| Mailing Address - Phone: | 01135129-557-3239 |
| Mailing Address - Fax: | 01135129-557-4214 |
| Practice Address - Street 1: | UNIT 7745 |
| Practice Address - Street 2: | |
| Practice Address - City: | APO |
| Practice Address - State: | AE |
| Practice Address - Zip Code: | 09720 |
| Practice Address - Country: | PT |
| Practice Address - Phone: | 01135129-557-3239 |
| Practice Address - Fax: | 01135129-557-4214 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-01-24 |
| Last Update Date: | 2025-09-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
| No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
| No | 261QE0002X | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 261QH0700X | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM1100X | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
| No | 261QM1101X | Ambulatory Health Care Facilities | Clinic/Center | Military and U.S. Coast Guard Ambulatory Procedure |
| No | 261QM1102X | Ambulatory Health Care Facilities | Clinic/Center | Military Outpatient Operational (Transportable) Component |
| No | 261QM1103X | Ambulatory Health Care Facilities | Clinic/Center | Military Ambulatory Procedure Visits Operational (Transportable) |
| No | 261QP0904X | Ambulatory Health Care Facilities | Clinic/Center | Public Health, Federal |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
