43Rd Medical Group

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

43RD MEDICAL GROUP

Practice address

383 Maynard St
43Rd Medical Group
Pope Afb, NC 28308-2321

Phone

(910) 394-2205

Fax

(910) 394-2077

NPI assigned

Jan 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Serena Lynn Hansken

Title

Air Force Uniform Business Office P

Phone

(703) 588-6419

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1619957586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 MAYNARD ST",
            "address_2": "43RD MEDICAL GROUP",
            "city": "POPE AFB",
            "state": "NC",
            "postal_code": "283082321",
            "telephone_number": "910-394-2205",
            "fax_number": "910-394-2077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 MAYNARD ST",
            "address_2": "43RD MEDICAL GROUP",
            "city": "POPE AFB",
            "state": "NC",
            "postal_code": "283082321",
            "telephone_number": "910-394-2205",
            "fax_number": "910-394-2077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "43RD MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "HANSKEN",
        "authorized_official_first_name": "SERENA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "AIR FORCE UNIFORM BUSINESS OFFICE P",
        "authorized_official_telephone_number": "703-588-6419"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "34-37313",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• AMC Womack-Ft Bragg
• Michael Edgar Bradley, D.D.S.
• Deborah Lynn Cahall, L.C.S.W.
• Christopher Michael Collier, D.D.S.
• Gwen Marie Compton Wear, IDMT

• All providers in Pope Afb, NC
• Military/U.S. Coast Guard Outpatient Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.