47TH MEDICAL GROUP (NPI# 1053399188) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053399188 |
| Entity Type | Organization |
| Organization Name | 47TH MEDICAL GROUP |
| Practice Address |
590 Mitchell Blvd Laughlin Afb TX 78843-5242 |
| Mailing Address |
590 Mitchell Blvd 47 Mdss Sgsrr Laughlin Afb TX 78843-5242 |
| Practice Telephone | 8303986320 |
| Practice Fax Number | 8302986439 |
| Mailing Telephone | 8303986320 |
| Mailing Fax Number | 8302986439 |
| Enumeration Date | 2006-01-09 |
| 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 |
|---|---|---|---|
| TX | PHARMACY NABP | 4510536 | 01 |
| TX | NCPDP | 4510536 | 01 |
| Street Address |
590 MITCHELL BLVD |
| City | LAUGHLIN AFB |
| State | TX |
| Zip Code | 78843-5242 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205236544 | Luke Czer | Dentist | 590 Mitchell Blvd, Laughlin Afb, TX 78843-5242 | 2014-08-22 |
| 1639414949 | Yuwen Wang | Dentist | 590 Mitchell Blvd, Building 375, Laughlin Afb, TX 78843 | 2012-11-28 |
| 1730484809 | Jennifer Hofmann | Dietitian, Registered | 590 Mitchell Blvd, Laughlin Afb, TX 78843-5242 | 2011-01-20 |
| 1679672893 | 47th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 590 Mitchell Blvd, Bldg 375, Laughlin Afb, TX 78843-5242 | 2006-09-22 |
| 1437167244 | Micheal H. Beto | Dentist | 590 Mitchell Blvd, Laughlin Afb, TX 78843-5244 | 2006-08-04 |
| 1992727077 | Robert Theodore Pohler | Pharmacist | 590 Mitchell Blvd, 47 Mdg/sgsap, Laughlin Afb, TX 78843 | 2006-07-24 |
| 1265404552 | Melinda Dawn Sams | Pharmacist | 590 Mitchell Blvd, 47 Mdg Pharmacy, Bldg 351, Laughlin Afb, TX 78843-5242 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427098011 | Maria Elisa Perez-johnson | Pediatrics | 315 Mitchell Blvd, 47th Mdg, Laughlin Afb, TX 78843 | 2006-06-08 |
| 1689144586 | Mi Casita Homecare, LLC. | Technician | 804 W. Edinburg Ave. Ste. D, Elsa, TX 78843-1614 | 2018-12-04 |
| 1184619520 | Patricia J Dalton | Nurse Practitioner | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2005-09-13 |
| 1356866107 | Elizabeth Heather Depalma | Nurse Practitioner | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2017-08-12 |
| 1760876791 | Susan J Ching | General Practice | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2015-03-27 |
| 1518374966 | 47 Mdss-laughlin Hospital | Military/U.S. Coast Guard Pharmacy | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2014-07-17 |
| 1396026597 | Stephen Ryan Emmerthal | Pharmacist | 590 Mitchell Blvd Bldg 375, Del Rio, TX 78843-5242 | 2011-08-31 |
| 1487932349 | Owen-john R. Williams | Psychologist | 590 Mitchell Blvd Bldg 375, 47th Mdg, Laughlin Afb, TX 78843-5242 | 2011-07-26 |
| 1386960946 | Felicia Ann Rinken | Optometrist | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2010-04-07 |
| 1790831816 | Micaela A Jett | Pediatrics | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2007-01-25 |
| Find all providers in zip 78843 | ||||
| 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 |
|---|---|---|---|---|
| 1326527177 | William Beaumont Army Medical Center | Clinic/Center | 11291 Sgt E Churchill St, Fort Bliss, TX 79918-8001 | 2018-08-13 |
| 1124505359 | Carl R Darnall Army Medical Center | Clinic/Center | 5200 Bunny Trail, Killeen, TX 76549 | 2018-07-20 |
| 1568948933 | Carl R Darnall Army Medical Center | Clinic/Center | 415 31st and 761st Tank Battalion, Fort Hood, TX 76544 | 2018-07-18 |
| 1740766112 | Carl R Darnall Army Medical Center | Clinic/Center | Bldg 2255 52nd and 761st Tank Battalion, Fort Hood, TX 76544 | 2018-07-18 |
| 1396119681 | Brooke Army Medical Center | Clinic/Center | 2407 N New Braunfels, Bldg 147, Ft Sam Houston, TX 78234 | 2015-11-24 |
| 1932595204 | Carl R Darnall Army Medical Center | Clinic/Center | 9410 19th St, Fort Hood, TX 76544 | 2015-04-13 |
| 1154717650 | Carl R Darnall Army Medical Center | Clinic/Center | 31002 74th Street, Fort Hood, TX 76544 | 2015-04-10 |
| 1073909578 | Carl R Darnall Army Medical Center | Clinic/Center | 37016 77th Street, Fort Hood, TX 76544 | 2015-04-10 |
| 1972999472 | Carl R Darnall Army Medical Center | Clinic/Center | 24001 Battalion Ave, 58th and 62nd Streets, Fort Hood, TX 76544 | 2015-04-10 |
| 1619365285 | Brooke Army Medical Center | Clinic/Center | 10010 Rogers Run, Suite 100, San Antonio, TX 78251-4403 | 2015-01-05 |
| Find all providers with the same taxonomy | ||||
| City | LAUGHLIN AFB |
| Zip Code | 78843 |
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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.