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12th Medical Group Randolph
Military/U.S. Coast Guard Pharmacy in Randolph A F B, Texas
NPI 1316911597

12th Medical Group Randolph is a Military/U.S. Coast Guard Pharmacy based in Randolph A F B, TX. 12th Medical Group Randolph practices in Randolph A F B, TX. The NPI Number for 12th Medical Group Randolph is 1316911597 and holds a License No. (Texas).

The current practice location address for 12th Medical Group Randolph is 221 3Rd St W, Randolph A F B, TX and can be reached out via phone at 210-652-2420 and via fax at 210-652-6571.

Location: 221 3Rd St W, Randolph A F B, TX, 78150-4800
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1316911597
Provider Name
12th Medical Group Randolph
Credential
Provider Entity Type
Organization
Address
221 3Rd St W, Randolph A F B, TX, 78150-4800
Phone Number
210-652-2420
Fax Number
210-652-6571
Provider Enumeration Date
02/15/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4512908 01 TX NCPDP
institution
Provider Business Practice Location Address Details
Address
221 3Rd St W
City
Randolph A F B
State
Texas
Zip
78150-4800
Phone Number
210-652-2420
Fax Number
210-652-6571
person
Provider Business Mailing Address Details
Address
221 3Rd St W
City
Randolph A F B
State
Texas
Zip
78150-4800
Phone Number
210-652-2420
Fax Number
210-652-6571
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Military/U.S. Coast Guard Outpatient
Taxonomy
261QM1100X
License No.
()
Definition
The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Military and U.S. Coast Guard Ambulatory Procedure
Taxonomy
261QM1101X
License No.
()
Definition
That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmaceuticals.
person
Provider's Taxonomy Details 3
Type
Suppliers
Classification
Military/U.S. Coast Guard Pharmacy
Speciality
-
Taxonomy
332000000X
License No.
()
Definition
A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services.
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