42D MEDICAL GROUP (NPI# 1033196878) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033196878 |
| Entity Type | Organization |
| Organization Name | 42D MEDICAL GROUP |
| Other Organization Name | MAXWELL AFB MTF |
| Practice Address |
300 South Twining St Building 760 Maxwell Afb AL 36112-6219 |
| Practice Telephone | 3349534943 |
| Practice Fax Number | 3349531741 |
| Mailing Telephone | 3349534943 |
| Mailing Fax Number | 3349531741 |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2014-03-03 |
| Authorized Official Name | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Authorized Official Telephone | 7036817613 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | NCPDP | 0127123 | 01 |
| Other Name | Type Code |
|---|---|
| Maxwell AFB MTF | Other Name - Individual/Organization |
| Street Address |
300 SOUTH TWINING ST BUILDING 760 |
| City | MAXWELL AFB |
| State | AL |
| Zip Code | 36112-6219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225021082 | Hector F Davila | Pediatrics | 300 South Twining St, Maxwell Afb, AL 36112 | 2005-08-26 |
| 1295961100 | Jason Daniel Hamilton | Physician Assistant | 300 South Twining St, Maxwell Afb, AL 36112 | 2009-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841836970 | Alison Bees Thompson | Social Worker | 42nd Medical Group, 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2019-11-25 |
| 1881245967 | Grant M Golombeski | Military Health Care Provider | 300 S Twinning Dr., Apo, AA 36112 | 2019-09-20 |
| 1477015196 | Jennifer Marie Hudson | Counselor | Jennifer Hudson, 300 South Twining St Bldg 760, Maxwell Afb, AL 36112 | 2019-04-02 |
| 1255801049 | Jose Edwin Aviles | Military Health Care Provider | Kelly Street, Montgomery, AL 36112 | 2018-12-05 |
| 1306316963 | Lydia Price Beringer | Speech-Language Pathologist | 300 S. Twining Street 42 Nd Medical Group, Maxwell Afb, AL 36112 | 2018-11-27 |
| 1114431301 | Dean M Kot | Physician Assistant | Mxf, Kelly St, Apo, AA 36112 | 2017-11-27 |
| 1417353590 | Jamie Ellis | Social Worker | 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2014-11-17 |
| 1629419650 | Elias N Hydrick | Family Medicine | 300 S. Twining St., Bldg 760, Maxwell Afb, 42nd Medical Group, Montgomery, AL 36112 | 2013-07-06 |
| 1639454200 | Sharon Lewis | Pharmacist | 300 Southtwining St, Montgomery, AL 36112 | 2011-10-14 |
| 1104158518 | Sylvia Ann Newell | Dietitian, Registered | 50 W Ash St Bldg 841, Montgomery, AL 36112 | 2010-02-10 |
| Find all providers in zip 36112 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| 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. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396738944 | Maxwell Afb Ambulatory Health Care Center | Clinic/Center | 300 S. Twining Street, Bldg 760, Family Practice - Yellow Team, Maxwell Afb, AL 36112 | 2005-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144423617 | United States Army Aeromedical Center | Clinic/Center | 4405 Innkeeper Street, Fort Rucker, AL 36362 | 2007-06-11 |
| 1932122314 | United States Army Aeromedical Center | Clinic/Center | 301 Andrews Rd, Fort Rucker, AL 36362 | 2006-07-25 |
| 1821410242 | Lyster Army Health Clinic | Clinic/Center | Lyster Army Health Clinic, Building 301 Andrews Avenue, Fort Rucker, AL 36362-5333 | 2014-01-21 |
| 1033532486 | Lyster Army Health Clinic | Clinic/Center | 301 Andrews Avenue, Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2014-01-21 |
| 1033541156 | Us Coast Guard | Clinic/Center | 8501 Tanner Williams Rd, Mobile, AL 36608-8322 | 2013-07-31 |
| 1760673784 | U. S. Coast Guard Aviation Training Center Mobile | Clinic/Center | 8501 Tanner Williams Rd, Mobile, AL 36608-8322 | 2007-08-05 |
| 1871796334 | Fox Army Health Center | Clinic/Center | 4100 Goss Rd Sw, Usadc-1, Huntsville, AL 35809-0001 | 2007-06-11 |
| 1790889053 | Centeral Alabama Veterans Health Care System | Clinic/Center | 215 Perry Hill Rd, Montgomery, AL 36109-3725 | 2006-09-08 |
| City | MAXWELL AFB |
| Zip Code | 36112 |
Please comment or provide details below to improve the information on 42D MEDICAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.