82 MEDICAL GROUP (NPI# 1073593570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073593570 |
| Entity Type | Organization |
| Organization Name | 82 MEDICAL GROUP |
| Other Organization Name | U.S. AIR FORCE |
| Practice Address |
149 Hart St Sheppard Afb TX 76311-3477 |
| Practice Telephone | 9406766075 |
| Practice Fax Number | 9406766076 |
| Mailing Telephone | 9406766075 |
| Mailing Fax Number | 9406766076 |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. CHRISTOPER JAMES REVIS (CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 9406764945 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
23872 | TX | Ambulatory Health Care Facilities |
| X | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| U.S. Air Force | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851376248 | 82 Medical Group | Clinic/Center | 149 Hart St, Ste 1, Sheppard Afb, TX 76311-3478 | 2005-12-08 |
| Street Address |
149 HART ST |
| City | SHEPPARD AFB |
| State | TX |
| Zip Code | 76311-3477 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336133123 | George Munkachy | Psychologist | 149 Hart St, 82nd Mdos/sgoh, Sheppard Afb, TX 76311-3477 | 2005-09-07 |
| 1861027476 | Taylor J Morgan | Pharmacist | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2020-03-04 |
| 1538721196 | Jennifer Eileen Brown | Nurse Practitioner | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2019-07-03 |
| 1174094551 | Tiffany Machelle Esparza | Social Worker | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2018-12-11 |
| 1235641713 | Natalie Mounts | Pharmacist | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2017-10-24 |
| 1730603978 | Kelly Lynn Hall | Physician Assistant | 149 Hart St, 82nd Mdos/sgop Family Practice, Sheppard Afb, TX 76354 | 2017-07-31 |
| 1588199129 | Julie Ojongofu | Pharmacist | 149 Hart St, 82 Mdg, Sheppard Afb, TX 76311-3430 | 2017-04-20 |
| 1437604469 | Marland Fox | Physician Assistant | 149 Hart St, Bldg 1200, Sheppard Afb, TX 76311-3430 | 2016-08-19 |
| 1386019669 | Matthew Robertson | Physical Therapist | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2015-12-11 |
| 1265818512 | Helena Guerra | Nurse Practitioner | 149 Hart St, Sheppard Afb, TX 76311-3430 | 2015-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740792076 | Hunter Tristan Justice Ferguson | Military Health Care Provider | 527 I Ave Unit 72, Sheppard Afb, TX 76311 | 2017-10-26 |
| 1588083356 | Keenan David Atwood | Emergency Medicine | 145 Hart St, Aerospace Medicine Clinic, Sheppard Afb, TX 76311 | 2014-04-09 |
| 1649525338 | Austin Douglas Solomons | Social Worker | 82 Medical Group, 149 Hart Street, Sheppard Afb, TX 76311 | 2012-07-18 |
| 1700162831 | Kristina Marie Zuccarelli | Student in an Organized Health Care Education/Training Program | 132 Hart Street, Sheppard Afb, TX 76311 | 2011-11-03 |
| 1679859367 | Brandon William Keyser | Dentist | 82 Dental Squadron/sgd, 149 Hart St Ste 4, Sheppard Afb, TX 76311 | 2011-10-26 |
| 1437456373 | Jennifer Leigh Noblin | Military Health Care Provider | Sheppard Afb Mental Health Clinic, 149 Hart St. Bldg 1200, Wichita Falls, TX 76311 | 2011-02-11 |
| 1336450444 | Allen Chan | Dentist | 82nd Medical Group (aetc) Pas: Sq0jfb5d, Sheppard Afb, Apo, AA 76311 | 2010-06-24 |
| 1003140344 | Christopher Shawn Couch | Military Health Care Provider | 718 I Ave 82 Mss/dpf, Bldg 1900 Dept Xufb, Sheppard Afb, TX 76311 | 2009-09-18 |
| 1124255583 | Danny Lee Dennis Jr. | Military Health Care Provider | 939 Missile Road Bld 1900, Wichita Falls, TX 76311 | 2009-06-12 |
| 1902008980 | Jason West Cromar | Military Hospital | 149 G W Hart St., Bldg. 1200, 82 Mdg/sgp, Sheppard Afb, TX 76311 | 2007-06-01 |
| Find all providers in zip 76311 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1154935476 | A Work of Heart Therapy, Pllc | Clinic/Center | 10650 Culebra Rd # 104-174, San Antonio, TX 78251-4949 | 2020-09-03 |
| 1144833625 | Mind Above Matter LLC | Clinic/Center | 5900 Hereford Dr, Fort Worth, TX 76179-3395 | 2020-08-25 |
| 1407469067 | Daybreak Wellness, Pllc | Clinic/Center | 1666 N Hampton Rd Ste 103, Desoto, TX 75115-2390 | 2020-08-24 |
| 1487263000 | Stay Young Mental Health & Wellness | Clinic/Center | 8209 Roughrider Dr Ste 210, Windcrest, TX 78239-2457 | 2020-07-29 |
| 1285242305 | Abide Counseling Pllc | Clinic/Center | 505 Church Ave Ste B, College Station, TX 77840-1336 | 2020-07-14 |
| 1275151912 | Inger Daniels Aprn | Clinic/Center | 1937 Texas Pkwy Ste A, Missouri City, TX 77489-3121 | 2020-07-09 |
| Find all providers with the same taxonomy | ||||
| City | SHEPPARD AFB |
| Zip Code | 76311 |
Please comment or provide details below to improve the information on 82 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.