99TH Medical Group, Nellis AFB

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5434 Issued in KY

Legal business name

99TH MEDICAL GROUP, NELLIS AFB

Practice address

4700 Las Vegas Blvd N
Mike O'Callaghan Federal Hospital
Nellis AFB, NV 89191-6600

Phone

(702) 653-2616

NPI assigned

Nov 10, 2005

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

Dr. Markham Brown, MD

Title

Chief of Medical Services

Phone

(702) 653-2000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1740261122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "address_2": "MIKE O'CALLAGHAN FEDERAL HOSPITAL",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "address_2": "MIKE O'CALLAGHAN FEDERAL HOSPITAL",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "99TH MEDICAL GROUP, NELLIS AFB",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-10",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MARKHAM",
        "authorized_official_title_or_position": "CHIEF OF MEDICAL SERVICES",
        "authorized_official_telephone_number": "702-653-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 99TH Medgrp-Nellis (DoD NELLIS ePhcy)
• 99TH Medical Group - Mike O'Callaghan Federal Hospital (99th MEDGRP-NELLIS)
• Cherylene S Abalos, D.O.
• Scott M Abbott, CRNA
• Olivia Abdoo
• Lisa Abiuso-Hayes, PMHNP-BC
• Erika Suda Abraham, M.D.

• General Practice Dentistry in Nellis AFB, NV
• Providers in Nellis AFB, NV by specialty
• General Practice Dentistry in Nevada

• 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.