Ellsworth Afb Mtf
LBN: 28Th Medical Group
Ellsworth Afb Mtf is an health care organization with primary practice located at 2900 Doolittle Dr , Ellsworth Afb SD 57706-4821. 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.
28Th Medical Group can be contacted via phone (605) 385-3311, or through Mitchell, Theresa Marie via phone (703) 681-7613.
Contact Information
Primary practice address
2900 Doolittle Dr
Ellsworth Afb SD 57706-4821
Phone: (605) 385-3311
Fax: (605) 385-3234
Website:
Health care specialties
| Specialty | Code | License # | 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 | 1023091642 |
|---|---|
| LBN Legal business name | 28Th Medical Group |
| DBA Doing business as | Ellsworth Afb Mtf |
| Authorized official | Mitchell, Theresa Marie |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Nov 29th, 2005 |
| Last updated | Mar 3rd, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1023091642 | NPPES |
| South Dakota | MEDICAID | 5351000 | |
| South Dakota | Other | 4304969 |
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