628 Medical Group

LBN: 628 Medical Group
628 Medical Group is an health care organization with primary practice located at 204 W Hill Blvd Bldg 364, Charleston Afb SC 29404-4704. 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. 628 Medical Group can be contacted via phone (843) 963-6884, or through Hansken, Serena Lynn via phone (703) 588-6419.

Contact Information

Primary practice address
204 W Hill Blvd Bldg 364 Charleston Afb SC 29404-4704
Phone: (843) 963-6884
Fax: (843) 963-6538
Website:
Map and Directions
Authorized official contact:
Name: Hansken, Serena Lynn
Phone: (703) 588-6419

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 1114905775
LBN Legal business name 628 Medical Group
DBA Doing business as
Authorized official Hansken, Serena Lynn
Entity Organization
Organization subpart 1 No
Enumeration date Jan 4th, 2006
Last updated Jan 27th, 2012 - about 13 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 1114905775 NPPES
South Carolina Other 42-22181 NCPDP

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