62D MEDICAL GROUP USAF (NPI# 1043270549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043270549 |
| Entity Type | Organization |
| Organization Name | 62D MEDICAL GROUP USAF |
| Practice Address |
690 A St Mcchord Afb WA 98438-1303 |
| Practice Telephone | 2539825586 |
| Practice Fax Number | 2539825978 |
| Mailing Telephone | 2539825586 |
| Mailing Fax Number | 2539825978 |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2010-11-12 |
| Authorized Official Name | SERENA LYNN HANSKEN (AIR FORCE UNIFORM BUSINESS OFFICE) |
| Authorized Official Telephone | 7035886419 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | NCPDP | 49-27197 | 01 |
| Street Address |
690 A ST |
| City | MCCHORD AFB |
| State | WA |
| Zip Code | 98438-1303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457810483 | Roveds Kaarins | Nursing Care | Mcchord Air Force Base Clinic, 690 Barnes Blvd Jblm Lakewood Wa, Apo, AA 98438 | 2019-03-19 |
| 1326459843 | Dr Larsen Eye Care Inc | Optometrist | 504 A St Mcchord Main Exchange, Ft. Lewis Mcchord Afb, WA 98438 | 2014-05-19 |
| 1548580392 | Kevin Lok | Family Medicine | 600 Barnes Blvd., Mcchord Medical Clinic, Jblm, WA 98438 | 2010-06-03 |
| 1720205578 | Nathan Kane Fosmore | Registered Nurse | Us Dept of The Us Airforce, 690 Barnes Blvd, Mcchord Afb, WA 98438 | 2007-04-20 |
| 1225176951 | Ronald Richardson Morris | Family Medicine | 690 Barnes Road, Mcchord Medical Clinic Fam Med Clinic, Joint Base Lewis Mcchord, WA 98438 | 2007-02-02 |
| 1770527418 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | A Street Bldg 504, Mcchord Afb, WA 98438 | 2006-06-15 |
| 1982660692 | Shanti Jones | Registered Nurse | 62nd Med Group, 690 Barnes Ave, Mcchord Afb, WA 98438 | 2006-04-21 |
| 1578547436 | Cynthia Lee Fry-spray | Physician Assistant | 691 Barnes Blvd, Mcchord Afb, WA 98438 | 2005-12-05 |
| 1366432171 | Robert Dean Rock | Dentist | 527 Barnes Blvd, Mcchord Air Forse Base Dental Clinic, Mcchord, WA 98438 | 2005-10-24 |
| 1457344913 | Norman Harris | Dentist | 62mdos/sgod 690 Barnes Blvd., Mcchord Afb, WA 98438 | 2005-08-30 |
| Find all providers in zip 98438 | ||||
| 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 |
|---|---|---|---|---|
| 1588812481 | Madigan Army Medical Ctr | Clinic/Center | 691 Barnes Blvd, Mcchord Afb, WA 98438-1303 | 2008-09-04 |
| 1609023274 | Madigan Army Medical Ctr | Clinic/Center | 690 Barnes Blvd, Mcchord Afb, WA 98438-1303 | 2008-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770975583 | Madigan Army Medical Ctr | Clinic/Center | Railroad Ave Bldg R3749, Tacoma, WA 98431-0001 | 2015-03-03 |
| 1376974303 | Madigan Army Medical Ctr | Clinic/Center | 3 Rd Division Dr Bldg R3150, Tacoma, WA 98431-0001 | 2013-12-02 |
| 1588094213 | Madigan Army Medical Ctr | Clinic/Center | C St Bldg R1880, Tacoma, WA 98431-0001 | 2013-11-15 |
| 1043640774 | Madigan Army Medical Ctr | Clinic/Center | Railroad Ave Bldg R3742, Tacoma, WA 98431-0001 | 2013-11-15 |
| 1750719761 | Madigan Army Medical Ctr | Clinic/Center | 5 Th St Bldg 9025, Tacoma, WA 98431-0001 | 2013-10-30 |
| 1801152723 | Madigan Army Medical Ctr | Clinic/Center | 13815 8th St, Joint Base Lewis Mcchord, WA 98431-0001 | 2012-04-04 |
| 1851605356 | Madigan Army Medical Ctr | Clinic/Center | 15600 Meridan Ave, Sunrise Village Center, East Puyallup, WA 98374 | 2010-07-27 |
| 1881907822 | Madigan Army Medical Ctr | Clinic/Center | 3415 Pacific Ave Se, Suite D1, Olympia, WA 98501-2173 | 2010-07-20 |
| 1497952667 | Madigan Army Medical Ctr | Clinic/Center | Building R3125, Bennett Avenue, Fort Lewis, WA 98433 | 2007-06-29 |
| 1992902571 | Madigan Army Medical Ctr | Clinic/Center | Dc#2 Building 3740p, Fort Lewis, WA 98433 | 2007-06-28 |
| Find all providers with the same taxonomy | ||||
| City | MCCHORD AFB |
| Zip Code | 98438 |
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| 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.