61St Medical Squadron

LBN: 61St Medical Squadron
61St Medical Squadron is an health care organization with primary practice located at 2420 Vela Way Suite 1866, El Segundo CA 90245-4659. 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. 61St Medical Squadron can be contacted via phone (310) 363-6640, or through Mitchell, Theresa M. via phone (703) 681-7613.

Contact Information

Primary practice address
2420 Vela Way Suite 1866 El Segundo CA 90245-4659
Phone: (310) 363-6640
Fax: (310) 363-0243
Website:
Map and Directions
Authorized official contact:
Name: Mitchell, Theresa M.
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 1538145412
LBN Legal business name 61St Medical Squadron
DBA Doing business as
Authorized official Mitchell, Theresa M.
Entity Organization
Organization subpart 1 No
Enumeration date Dec 21st, 2005
Last updated May 21st, 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 1538145412 NPPES
California Other 05-37918 NCPDP

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