| United States Air Force | |
|
204 W Hill Blvd Charleston Afb SC 29404-4704 | |
| (843) 963-6936 | |
| (843) 963-6903 |
| Full Name | United States Air Force |
|---|---|
| Speciality | Clinic/center |
| Location | 204 W Hill Blvd, Charleston Afb, South Carolina |
| Authorized Official Name and Position | Ronnie Lee Godbolt (INDEPENDENT DUTY MEDICAL TECHNICIAN) |
| Authorized Official Contact | 8439636936 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| United States Air Force 204 W Hill Blvd Charleston Afb SC 29404-4704 Ph: (843) 963-6936 | United States Air Force 204 W Hill Blvd Charleston Afb SC 29404-4704 Ph: (843) 963-6936 |
| NPI Number | 1023246659 |
|---|---|
| Provider Enumeration Date | 06/22/2009 |
| Last Update Date | 06/22/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023246659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |