355TH MEDICAL GROUP SGSL (NPI# 1093814154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093814154 |
| Entity Type | Organization |
| Organization Name | 355TH MEDICAL GROUP SGSL |
| Other Organization Name | DAVISMON MAIN PHCY335TH MDG |
| Practice Address |
4175 S Alamo Ave Davismonthan Afb Tucson AZ 85707-4402 |
| Practice Telephone | 5202282626 |
| Practice Fax Number | 5202282604 |
| Mailing Telephone | 5202282626 |
| Mailing Fax Number | 5202282604 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-05-22 |
| 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 | 1989953 | 01 |
| Other Name | Type Code |
|---|---|
| DAVISMON MAIN PHCY335TH MDG | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205935244 | 355th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 2714 Bola Ave, Tucson, AZ 85707 | 2006-09-22 |
| Street Address |
4175 S ALAMO AVE DAVISMONTHAN AFB |
| City | TUCSON |
| State | AZ |
| Zip Code | 85707-4402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760956387 | Kyle Lynn Craver | Military Health Care Provider | 4175 S Alamo Ave, Tucson, AZ 85707 | 2019-01-16 |
| 1396216099 | Laura Bette | Social Worker | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2018-12-07 |
| 1679048250 | Lam T Chung | Pharmacist | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2018-10-10 |
| 1811477235 | Alan Thatcher Price | Military Health Care Provider | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2018-08-15 |
| 1841776101 | Kimberly Johnson | Nurse Practitioner | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2018-07-19 |
| 1457868598 | Kristina Marie Linden | Social Worker | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2018-01-10 |
| 1235668054 | Joseph Anthony Everett | Dentist | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2017-06-06 |
| 1407205743 | Eun Soo David Park | Family Medicine | 4175 S Alamo Ave, Tucson, AZ 85707 | 2016-06-07 |
| 1477907590 | Vanessa F Scheirer | Physical Therapist | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2016-04-14 |
| 1164883104 | Marc Enslow | Dentist | 4175 S Alamo Ave, Tucson, AZ 85707-4402 | 2016-03-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699128850 | Megan Dehaven | Specialist/Technologist | 5455 E Comanche St, Tucson, AZ 85707 | 2016-07-22 |
| 1780927954 | Ryan N Taylor | Physician Assistant | 400, 4175 S Alamo Ave, Davis-monthan Afb, AZ 85707 | 2013-04-05 |
| 1154658839 | Alisha A Marchetti | Physician Assistant | 4175 S. Alamo Avenue, 355th Mdg/mdos, Davis-monthan Afb, AZ 85707 | 2009-11-17 |
| 1851529192 | Christopher Thomas Yarbrough | Military Health Care Provider | 4625 South Phoenix Street Bldg 4843, Tucson, AZ 85707 | 2009-06-25 |
| 1144457045 | Denise Fabian | Psychiatry & Neurology | 5427 E. Madera Street, Davis Monthan Afb, AZ 85707 | 2009-06-17 |
| 1942437447 | Emerson M Earle | Military Health Care Provider | 4625 S. Phoenix St, Bld 4843, Tucson, AZ 85707 | 2009-06-11 |
| 1164657136 | Raul Romero | Military Health Care Provider | 4575 S. Phoenix St. 563rd Oss, Dmafb, AZ 85707 | 2009-05-20 |
| 1063647196 | Virginia E. Bailey | Military Health Care Provider | 4837 S Phoenix St., Rm 119 Davis-monthan Air Force Base, Tucson, AZ 85707 | 2009-05-19 |
| 1043417611 | Jacob Riis | Orthopaedic Surgery | 355 Mdg, 4175 South Alamo Ave, Tucson, AZ 85707 | 2007-06-28 |
| 1508989732 | Christopher E. Dunham | Physician Assistant | 4175 S. Alamo Ave Bldg 400, 355th Medical Group-davis Monthan Afb, Tucson, AZ 85707 | 2007-04-10 |
| Find all providers in zip 85707 | ||||
| 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 |
|---|---|---|---|---|
| 1205935244 | 355th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 2714 Bola Ave, Tucson, AZ 85707 | 2006-09-22 |
| 1245210384 | 355 Mdg | Military/U.S. Coast Guard Pharmacy | 4175 S Alamo Ave, Tucson, AZ 85707-6097 | 2006-01-17 |
| 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 |
| 1306945472 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | Bldg 810, Luke Afb, AZ 85309 | 2006-09-22 |
| 1396844338 | Weed Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 990, Yuma, AZ 85365 | 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.