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99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL NPI 1629130612


NPI Information

NPI: 1629130612
Provider Name: 99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL

Doing Business As: NELLIS VA OUTPATIENT PHCY

Classification: Military/U.S. Coast Guard Pharmacy - 332000000X
Entity Type: Organization
Address:
MIKE O CALLAGHAN FEDERAL HOSP/SGSAP
4700 LAS VEGAS BLVD NORTH BLDG 1300
NELLIS AFB, NV
ZIP 89191
Phone: (702) 653-3201
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99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL is a military us coast guard pharmacy in Nellis Afb, NV. The provider is a Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. 99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL NPI is 1629130612. The provider is registered as an organization entity type.
The provider Is Doing Business As Nellis Va Outpatient Phcy.

The provider's business location address is:

MIKE O CALLAGHAN FEDERAL HOSP/SGSAP
4700 LAS VEGAS BLVD NORTH BLDG 1300
NELLIS AFB, NV
ZIP 89191
Phone: (702) 653-3201
Fax: (702) 653-2171

The provider's authorized official is Hector Morales .
The authorized official title is Chief Dha Pass and has the following contact phone number (210) 536-6650.

The enumeration date for this NPI number is 12/15/2006 and was last updated on 1/11/2016.


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 License Number License State Primary
1333600000XPharmacyNo
2332000000XMilitary/U.S. Coast Guard PharmacyYes

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
12051663OTHERPK

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: 5/5/2024

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