42D MEDICAL GROUP NPI 1033196878

NPI Information

NPI: 1033196878
Provider Name: 42D MEDICAL GROUP
Classification: Clinic/Center - 261QM1100X
Specialization: Military/U.S. Coast Guard Outpatient
Entity Type: Organization
:
Address: 300 SOUTH TWINING ST
BUILDING 760
MAXWELL AFB, AL
ZIP 36112
Phone: (334) 953-4943

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NPI Details

42D MEDICAL GROUP is a military/u.s. coast guard outpatient clinic center in Maxwell Afb, AL. The provider is the Defense Health Program or U.S. Coast Guard funded fixed facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A fixed facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the fixed facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. 42D MEDICAL GROUP NPI is 1033196878. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

300 SOUTH TWINING ST
BUILDING 760
MAXWELL AFB, AL
ZIP 36112-219
Phone: (334) 953-4943
Fax: (334) 953-1741

The provider's authorized official is William Michael Condon .
The authorized official title is Defense Health Agency (dha) Financi and has the following contact phone number (240) 401-3643.

The enumeration date for this NPI number is 12/22/2005 and was last updated on 2/18/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM1100X	Clinic/Center	Military/U.S. Coast Guard Outpatient	Yes
2	261QM1101X	Clinic/Center	Military and U.S. Coast Guard Ambulatory Procedure	No
3	332000000X	Military/U.S. Coast Guard Pharmacy		No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0127123	OTHER	ALABAMA	NCPDP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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