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4TH MEDICAL GROUP NPI 1831173558


NPI Information

NPI: 1831173558
Provider Name: 4TH MEDICAL GROUP
Classification: Clinic/Center - 261QM1100X
Entity Type: Organization

Specialization: Military/U.S. Coast Guard Outpatient

Address:
2803 MEDICAL CAMPUS DRIVE
SEYMOUR JOHNSON AFB, NC
ZIP 27531
Phone: (919) 722-8257
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4TH MEDICAL GROUP is a military/u.s. coast guard outpatient clinic center in Seymour Johnson Afb, NC. 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. 4TH MEDICAL GROUP NPI is 1831173558. The provider is registered as an organization entity type.

The provider's business location address is:

2803 MEDICAL CAMPUS DRIVE
SEYMOUR JOHNSON AFB, NC
ZIP 27531-310
Phone: (919) 722-8257

The provider's authorized official is Tiffany Lighthill .
The authorized official title is Ncoic, Uniform Business Office and has the following contact phone number (919) 722-8257.

The enumeration date for this NPI number is 12/6/2005 and was last updated on 4/25/2023.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM1101XClinic/CenterMilitary and U.S. Coast Guard Ambulatory ProcedureNORTH CAROLINANo
2332000000XMilitary/U.S. Coast Guard PharmacyNo
3261QM1100XClinic/CenterMilitary/U.S. Coast Guard OutpatientNORTH CAROLINAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13429405OTHERNORTH CAROLINANCPDP

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: 4/28/2024

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