Organization · Type 2 NPI

17th Medgrp-Goodfellow

Military/U.S. Coast Guard Outpatient Clinic/Center · Goodfellow Afb, TX

NPI number 1104805142 Active

Practice location

271 Fort Richardson Ave
Goodfellow Afb, TX 76908-4901

Fax (325) 654-3121

Specialties and licenses

Taxonomy	Code	License
Military/U.S. Coast Guard Outpatient Clinic/Center Primary	261QM1100X	None listed
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center	261QM1101X	None listed
Military/U.S. Coast Guard Pharmacy	332000000X	None listed

Military/U.S. Coast Guard Outpatient Clinic/Center: 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 exam…

45 other providers at this address

About NPI 1104805142

17th Medgrp-Goodfellow's National Provider Identifier is 1104805142, issued on Jan 10, 2006. The primary taxonomy on file is Military/U.S. Coast Guard Outpatient Clinic/Center (261QM1100X), and the practice location is in Goodfellow Afb, TX. The record was last updated on Jun 17, 2025.