Moody Afb Mtf

LBN: 23 Mdg
Moody Afb Mtf is an health care organization with primary practice located at 3278 Mitchell Blvd , Moody Afb GA 31699-1500. The organization recently has 3 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient, Ambulatory Health Care Facilities / Military and U.S. Coast Guard Ambulatory Procedure, Suppliers / Military/U.S. Coast Guard Pharmacy. Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient is the primary health care specialty. 23 Mdg can be contacted via phone (229) 257-3041, or through Mitchell, Theresa Marie via phone (703) 681-7613.

Contact Information

Primary practice address
3278 Mitchell Blvd Moody Afb GA 31699-1500
Phone: (229) 257-3041
Fax: (229) 257-5528
Website:
Map and Directions
Authorized official contact:
Name: Mitchell, Theresa Marie
Phone: (703) 681-7613

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient 261QM1100X
Ambulatory Health Care Facilities / Military and U.S. Coast Guard Ambulatory Procedure 261QM1101X
Suppliers / Military/U.S. Coast Guard Pharmacy 332000000X

Profile Details

NPI number 1316907744
LBN Legal business name 23 Mdg
DBA Doing business as Moody Afb Mtf
Authorized official Mitchell, Theresa Marie
Entity Organization
Organization subpart 1 No
Enumeration date Mar 28th, 2006
Last updated Mar 6th, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316907744 NPPES
Georgia Other 1142784 NCPDP
Georgia Other 1689773350 NCPDP

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