Randolph Afb Clinic

LBN: 12Th Medical Group Randolph
Randolph Afb Clinic is an health care organization with primary practice located at 221 3Rd St W Bldg 1040, Randolph A F B TX 78150-4800. The organization recently has 3 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient, Ambulatory Health Care Facilities / Military and U.S. Coast Guard Ambulatory Procedure, Suppliers / Military/U.S. Coast Guard Pharmacy. Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient is the primary health care specialty. 12Th Medical Group Randolph can be contacted via phone (210) 652-2420, or through Hansken, Serena Lynn via phone (703) 588-6419.

Contact Information

Primary practice address
221 3Rd St W Bldg 1040 Randolph A F B TX 78150-4800
Phone: (210) 652-2420
Fax: (210) 652-6571
Website:
Map and Directions
Authorized official contact:
Name: Hansken, Serena Lynn
Phone: (703) 588-6419

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient 261QM1100X
Ambulatory Health Care Facilities / Military and U.S. Coast Guard Ambulatory Procedure 261QM1101X
Suppliers / Military/U.S. Coast Guard Pharmacy 332000000X

Profile Details

NPI number 1316911597
LBN Legal business name 12Th Medical Group Randolph
DBA Doing business as Randolph Afb Clinic
Authorized official Hansken, Serena Lynn
Entity Organization
Organization subpart 1 No
Enumeration date Feb 15th, 2006
Last updated Nov 15th, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316911597 NPPES
Texas Other 4512908 NCPDP

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