Hickam Afb 15TH MDG

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

14816 Issued in HI

Legal business name

HICKAM AFB 15TH MDG

Practice address

755 Scott Cir
15TH Med Group
Hickam Afb, HI 96853-5399

Phone

(808) 448-6133

NPI assigned

Nov 16, 2007

Organization subpart

No

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

Authorized official

Name

Mercedes Hamilton, LPN

Title

Referral Manager

Phone

(808) 448-6133

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1952582009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 SCOTT CIR",
            "address_2": "15TH MED GROUP",
            "city": "HICKAM AFB",
            "state": "HI",
            "postal_code": "968535399",
            "telephone_number": "808-448-6133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 SCOTT CIR",
            "address_2": "15TH MED GROUP",
            "city": "HICKAM AFB",
            "state": "HI",
            "postal_code": "968535399",
            "telephone_number": "808-448-6133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKAM AFB 15TH MDG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "MERCEDES",
        "authorized_official_title_or_position": "REFERRAL MANAGER",
        "authorized_official_telephone_number": "808-448-6133",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "HI",
            "license": "14816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Garrett, D.M.D.
• Caitlin Rose Guthrie, DPT
• Tina Hairston
• Anthony Mark Hall, CADAC
• Robert Hetue, PHARMD
• Hickam Phcy
• Michael Johnson Hsu, PHARM D
• Yvonne M Johnson, PA
• Micah T Keaney, PSYD
• John Hankil Kim, D.O.

• Primary Care Clinic/Center in Hickam Afb, HI
• Providers in Hickam Afb, HI by specialty
• Primary Care Clinic/Center in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.