Organization · Type 2 NPI
628th Medgrp-Charleston
Military/U.S. Coast Guard Outpatient Clinic/Center · Charleston Afb, SC
Practice location
204 W Hill Blvd, Bldg 364
Charleston Afb, SC 29404-4704
Fax (843) 963-6538
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…
80 other providers at this address
- United States Air ForceClinic/Center Charleston Afb, SC NPI 1023246659
- Alaine Mills, R.D.Registered Dietitian Joint Base Charleston, SC NPI 1770922684
- Albert Joseph PendletonIndependent Duty Medical Technicians Joint Base Charleston, SC NPI 1588299457
- Alena WroePhysician Assistant Charleston Afb, SC NPI 1659132413
- Allison Marie Deatherage, PhDClinical Psychologist Charleston Afb, SC NPI 1659585099
- Alysha BuonerbaClinical Psychologist Joint Base Charleston, SC NPI 1487212742
- Amogh Krishnagiri, DOEmergency Medicine Physician Charleston Afb, SC NPI 1467156513
- Angela R. Fitzpatrick, DDSDentist Charleston Afb, SC NPI 1871785113
- Bibek Joshi, MDFamily Medicine Physician Charleston Afb, SC NPI 1205365970
- Bob Keophakdy, IDMTIndependent Duty Medical Technicians Charleston, SC NPI 1124797410
- Brandon Stoker, IDMTIndependent Duty Medical Technicians Charleston, SC NPI 1205294550
- Brett Randall, IDMTIndependent Duty Medical Technicians Charleston Afb, SC NPI 1114261526
About NPI 1114905775
628th Medgrp-Charleston's National Provider Identifier is 1114905775, issued on Jan 4, 2006. The primary taxonomy on file is Military/U.S. Coast Guard Outpatient Clinic/Center (261QM1100X), and the practice location is in Charleston Afb, SC. The record was last updated on Jun 17, 2025.