56TH MEDICAL GROUP (NPI# 1043627631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043627631 |
| Entity Type | Organization |
| Organization Name | 56TH MEDICAL GROUP |
| Other Organization Name | DOD LUKE EPHCY |
| Practice Address |
7219 N Litchfield Rd Bldg 1130 Luke Afb AZ 85309-1529 |
| Mailing Address |
56th Medical Group C/o Jame Mitchell 7219 N. Litchfield Rd. Luke Afb AZ 85309 |
| Practice Telephone | 6238563934 |
| Practice Fax Number | 6238563616 |
| Mailing Telephone | 6238563934 |
| Mailing Fax Number | 6238563616 |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2016-03-30 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2146879 | 01 |
| Other Name | Type Code |
|---|---|
| DoD LUKE ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194700971 | 56th Medical Group | Military/U.S. Coast Guard Pharmacy | 7219 N Litchfield Rd, Luke Afb, AZ 85309 | 2005-12-14 |
| Street Address |
7219 N LITCHFIELD RD BLDG 1130 |
| City | LUKE AFB |
| State | AZ |
| Zip Code | 85309-1529 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992122543 | Jessica Behrens | Pharmacist | 7219 N Litchfield Rd Bldg 1130, Luke Afb, AZ 85309-1529 | 2014-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912466111 | Natalie Ann Korona | Nurse Practitioner | 56 Mdg/mdos/sgof, 7219 N. Litchfield Rd, Luke Afb, AZ 85309 | 2019-03-18 |
| 1558647024 | Cheng Chung Tsai | Pharmacist | 72 19 N Litchfield Road, 56 Medical Group, Luke Afb, AZ 85309 | 2011-10-28 |
| 1053617464 | Bradley William Snyder | Military Health Care Provider | 7224 North 139th Avenue, Glendale, AZ 85309 | 2011-02-02 |
| 1043516610 | Charles Delvon Pickett | Military Health Care Provider | 7019 N Litchfield Ave, Luke Afb, 56/amds, Luke Afb, AZ 85309 | 2011-01-31 |
| 1104980663 | Maurice Edgar Young | Obstetrics & Gynecology | 56th Aerospace Medicine Squadron, Luke Afb, AZ 85309 | 2006-12-20 |
| 1679658538 | Wayne Allen Beaver | Psychologist | Luke Air Force Base, Bldg 317, Glendale, AZ 85309 | 2006-10-26 |
| 1306945472 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | Bldg 810, Luke Afb, AZ 85309 | 2006-09-22 |
| 1679676571 | Anita Glenn-reller | Counselor | 317 Lightning Ave, Luke Afb, AZ 85309 | 2006-09-06 |
| 1720402993 | Samuel Beck | Pediatrics | 7219 N Litchfield Rd, Luke Afb, AZ 85309 | 2014-02-09 |
| 1902162258 | Joshua Lemoyne Pringle | Surgery | 7219 N Litchfield Rd, Luke Afb, AZ 85309 | 2012-04-11 |
| Find all providers in zip 85309 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306945472 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | Bldg 810, Luke Afb, AZ 85309 | 2006-09-22 |
| 1417056458 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2006-09-22 |
| 1215036389 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2006-09-22 |
| 1487753521 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 7219 N Litchfield Rd, Bldg 1130 Rm C04, Luke Afb, AZ 85309-1529 | 2006-09-22 |
| 1780781534 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2006-09-20 |
| 1194700971 | 56th Medical Group | Military/U.S. Coast Guard Pharmacy | 7219 N Litchfield Rd, Luke Afb, AZ 85309 | 2005-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942697685 | Naval Hospital Camp Pendleton | Military/U.S. Coast Guard Pharmacy | Marine Corps Air Station, Bldg 1175, Yuma, AZ 85369 | 2015-04-21 |
| 1710391156 | Raymond W Bliss Army Health Center | Military/U.S. Coast Guard Pharmacy | 2240 Winrow Rd Bldg 45001, Raymond W. Bliss Army Health Center, Fort Huachuca, AZ 85613-5080 | 2014-06-13 |
| 1467864090 | Weed Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 301 C St Bldg 990, Us Army Health Clinic,yuma Proving Ground, Ypg, AZ 85365-9498 | 2014-06-02 |
| 1477617124 | Raymond W. Bliss Army Health Center | Military/U.S. Coast Guard Pharmacy | 2w Bliss Army Health Center 45001, Ft Huachuca, AZ 85613 | 2006-12-20 |
| 1972693208 | Yuma Flas Phcy | Military/U.S. Coast Guard Pharmacy | Bmc Bldg 1175, Yuma, AZ 85369-9116 | 2006-10-16 |
| 1427148758 | Naval Hospital Camp Pendleton | Military/U.S. Coast Guard Pharmacy | Bhc Marine Corp Air Station, Bldg 1175, Yuma, AZ 85369 | 2006-10-16 |
| 1396844338 | Weed Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 990, Yuma, AZ 85365 | 2006-09-22 |
| 1205935244 | 355th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 2714 Bola Ave, Tucson, AZ 85707 | 2006-09-22 |
| 1114026150 | Raymond W Bliss Army Health Center | Military/U.S. Coast Guard Pharmacy | 2 W Bliss Army Health Ctr, Bldg 45001, Ft Huachuca, AZ 85613 | 2006-09-22 |
| 1699162339 | Naval Hospital Camp Pendleton | Military/U.S. Coast Guard Pharmacy | Bhc Marine Corp Air Station, Bldg 1175, Yuma, AZ 85369 | 2015-04-21 |
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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.