419 Medical Squadron

Primary specialty

Substance Use Disorder Rehabilitation Hospital UnitTaxonomy code 276400000X

License

06477 Issued in IA

Legal business name

419 MEDICAL SQUADRON

Practice address

7311 11TH St
Hill AFB, UT 84056-5012

Phone

(801) 777-2622

NPI assigned

Jul 17, 2006

Last updated

Jun 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert Atisme, LISW, CSW

Title

Mental Health Therapist

Phone

(801) 777-2622

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1689691230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3626 W 2000 N",
            "city": "WEST POINT",
            "state": "UT",
            "postal_code": "840157300",
            "telephone_number": "801-776-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7311 11TH ST",
            "city": "HILL AFB",
            "state": "UT",
            "postal_code": "840565012",
            "telephone_number": "801-777-2622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "419 MEDICAL SQUADRON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "ATISME",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MENTAL HEALTH THERAPIST",
        "authorized_official_telephone_number": "801-777-2622",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LISW, CSW"
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "IA",
            "license": "06477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 75TH Medgrp-Hill (Dod Hill Pharmacy)
• 75TH Medgrp-Hill
• Joseph Lincoln Abrams, D.O.
• Dellray H Anderson, M.D.
• Ray J Angel, IDMT

• Substance Use Disorder Rehabilitation Hospital Unit in Hill AFB, UT
• Providers in Hill AFB, UT by specialty
• Substance Use Disorder Rehabilitation Hospital Unit in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.