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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WA | NCPDP | 49-24507 | 01 |
Other Name | Type Code |
---|---|
Fairchild AFB MTF | Other Name - Individual/Organization |
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 |
Street Address |
701 HOSPITAL LOOP |
City | FAIRCHILD AFB |
State | WA |
Zip Code | 99011-8704 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 99011 |
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 |
---|---|---|---|---|
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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City | FAIRCHILD AFB |
Zip Code | 99011 |
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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.