Provider Demographics
NPI:1699987438
Name:U.S. MARINE CORPS FORCES COMMAND
Entity type:Organization
Organization Name:U.S. MARINE CORPS FORCES COMMAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP SURGEON, 2D MARINE LOG GRP
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-450-6672
Mailing Address - Street 1:HEALTH SERVICES SUPPORT 1468 INGRAM ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23551-2596
Mailing Address - Country:US
Mailing Address - Phone:757-836-1685
Mailing Address - Fax:
Practice Address - Street 1:CLR-27, 2D MLG, PSC BOX 20125
Practice Address - Street 2:BLDG 308, HOLCOLM BLVD.
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-450-6672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-6125261QM1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient