Provider Demographics
NPI:1184073181
Name:81MSGS/SGCQ
Entity type:Organization
Organization Name:81MSGS/SGCQ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-833-2295
Mailing Address - Street 1:301 FISHER ST, RM 5A127
Mailing Address - Street 2:81MSGS/SGCQ
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:81MSGS/SGCQ
Practice Address - Street 2:301 FISHER ST, RM 5A127
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:210-833-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital