Provider Demographics
NPI:1043622681
Name:60TH MEDGRP-TRAVIS
Entity type:Organization
Organization Name:60TH MEDGRP-TRAVIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:DAVID S GRANT MEDICAL CENTER CO 60TH MDG
Mailing Address - Street 2:101 BODIN CIR
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-423-7657
Mailing Address - Fax:707-423-7994
Practice Address - Street 1:461 SKYMASTER CIR RM 149
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1909
Practice Address - Country:US
Practice Address - Phone:707-423-5345
Practice Address - Fax:707-423-5346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:60TH MEDICAL GROUP - TRAVIS AFB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-02
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146026OtherPK