Provider Demographics
NPI:1538629415
Name:6TH MEDICAL GROUP
Entity type:Organization
Organization Name:6TH MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MTF SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6096
Mailing Address - Street 1:3250 ZEMKE AVE BLDG 1078
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33621-5023
Mailing Address - Country:US
Mailing Address - Phone:813-827-7910
Mailing Address - Fax:813-828-0088
Practice Address - Street 1:3250 ZEMKE AVE BLDG 1078
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5023
Practice Address - Country:US
Practice Address - Phone:813-827-7910
Practice Address - Fax:813-828-0088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:6TH MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy