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:
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 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023091642 NPPES
South Dakota MEDICAID 5351000
South Dakota Other 4304969

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