92ND MEDICAL GROUP


Address: 701 Hospital Loop, Fairchild Afb, WA 99011-8704
Phone: 5092479264

92ND MEDICAL GROUP (NPI# 1104888288) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104888288
Entity Type Organization
Organization Name 92ND MEDICAL GROUP
Other Organization Name FAIRCHILD AFB MTF
Practice Address 701 Hospital Loop
Fairchild Afb
WA 99011-8704
Practice Telephone 5092479264
Practice Fax Number 5092473535
Mailing Telephone 5092479264
Mailing Fax Number 5092473535
Enumeration Date 2006-04-04
Last Update Date 2014-03-10
Authorized Official Name THERESA MARIE MITCHELL (AIR FORCE UBO)
Authorized Official Telephone 7036817613
Is Organization Subpart N

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
WA NCPDP 49-24507 01

Other Provider/Organization Names

Other Name Type Code
Fairchild AFB MTF Other Name - Individual/Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1205102761 92nd Medical Group Military/U.S. Coast Guard Pharmacy 103 Saatz Rd, Fairchild Afb, WA 99011 2012-03-29
1275632317 92nd Medical Group Military/U.S. Coast Guard Pharmacy Bldg 2460, Fairchild Afb, WA 99011 2006-09-22
1477652519 92nd Medical Group Military/U.S. Coast Guard Pharmacy 701 Hospital Loop # 135, Fairchild Afb, WA 99011-8704 2006-09-22
1922411529 92nd Medical Group Military/U.S. Coast Guard Pharmacy 701 Hospital Loop Bldg 9000, Fairchild Afb, WA 99011-8704 2014-06-11

Office Location

Street Address 701 HOSPITAL LOOP
City FAIRCHILD AFB
State WA
Zip Code 99011-8704

Providers in the same location

NPI Name Taxonomy Address Enumeration
1568927168 Scott Gilbert Social Worker 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2019-02-07
1750872453 Andrew Hamilton Dentist 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2018-05-29
1497250211 Courtney Beaver Student in an Organized Health Care Education/Training Program 701 Hospital Loop, Fairchild Afb, WA 99011 2018-03-25
1730691148 Bryce Ferland Military Health Care Provider 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2017-10-26
1780113886 Jacob William Thomas Family Medicine 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2017-06-12
1184166977 Nathan James Dillow Military Health Care Provider 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2016-11-09
1770936940 Jeremy Thompson Physician Assistant 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2016-07-22
1578916383 Megan Gaschk Student in an Organized Health Care Education/Training Program 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2016-07-16
1598116329 Roger Joel Brogis II Emergency Medicine 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2016-06-22
1801241476 Nicholas Forster-curnew Military Health Care Provider 701 Hospital Loop, Fairchild Afb, WA 99011-8704 2016-05-02
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1669939732 Ruth Ann Sunde Social Worker 92d Medical Group/sgow, 701 Hospital Loop, Suite 259, Fairchild Afb, WA 99011 2019-02-26
1164992491 Michael Thomas Stevens Military Health Care Provider 100 Hospital Loop, Fairchild Afb, WA 99011 2018-11-29
1174032569 Elizabeth Andrews Registered Nurse 400 W Fairchild Highway, Fairchild Afb, WA 99011 2017-09-28
1770031171 Mariah Combs Behavioral Analyst 5298 B Sycamore Street, Fairchild Afb, WA 99011 2016-09-14
1770960957 Usv Optical Inc. Eyewear Supplier (Equipment, not the service) 101 W. Spaatz Rd., Bldg 2465, Fairchild Afb, WA 99011 2015-04-27
1306191689 Patricia Kaye Catrow Family Medicine 701 Hospital Loop Bldg 9000, Fairchild Afb, WA 99011 2012-07-23
1205102761 92nd Medical Group Military/U.S. Coast Guard Pharmacy 103 Saatz Rd, Fairchild Afb, WA 99011 2012-03-29
1992078554 Alyssa Marie Degeyter Community Health Worker 7272 A Nebraska Ave, Fairchild Air Force Base, WA 99011 2012-02-13
1730317728 Nicholas James Graham Military Health Care Provider 2504 S.chicago St, Fairchild Afb, WA 99011 2009-06-29
1922232099 Pocco S Bussey Military Health Care Provider 92 Medical Group, Flight Medicine Clinic, Fairchild, WA 99011 2009-05-05
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Taxonomy Information

Taxonomy Code 261QM1100X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Military/U.S. Coast Guard Outpatient

Taxonomy Definition

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]

Providers in the same taxonomy and state

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
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Competitor

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City FAIRCHILD AFB
Zip Code 99011

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Dataset Information

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.

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