92ND MEDICAL GROUP (NPI# 1205102761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205102761 |
| Entity Type | Organization |
| Organization Name | 92ND MEDICAL GROUP |
| Other Organization Name | FAIRCHID SCM PHCY |
| Practice Address |
103 Saatz Rd Fairchild Afb WA 99011 |
| Mailing Address |
92rd Medical Group Rmo Office 3rd Party Collections 701 Hospital Loop Fairchild Afb WA 99011-8704 |
| Practice Telephone | 5092475567 |
| Practice Fax Number | 5092472021 |
| Mailing Telephone | 5092475567 |
| Mailing Fax Number | 5092472021 |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2015-06-12 |
| 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 | 2134472 | 01 |
| Other Name | Type Code |
|---|---|
| FAIRCHID SCM PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1104888288 | 92nd Medical Group | Military/U.S. Coast Guard Pharmacy | 701 Hospital Loop, Fairchild Afb, WA 99011-8704 | 2006-04-04 |
| Street Address |
103 SAATZ RD |
| City | FAIRCHILD AFB |
| State | WA |
| Zip Code | 99011 |
| 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 |
| 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 |
| 1043403603 | Alyson L Kresser | Nutritionist | 92 Amds/sgpz, 701 Hospital Loop, Fairchild Air Force Base, WA 99011 | 2007-08-27 |
| Find all providers in zip 99011 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1215099189 | 92 Medical Group | Military/U.S. Coast Guard Pharmacy | 701 Hospital Loop, Suite 135, Fairchild Afb, WA 99011-8704 | 2006-12-15 |
| 1104888288 | 92nd Medical Group | Military/U.S. Coast Guard Pharmacy | 701 Hospital Loop, Fairchild Afb, WA 99011-8704 | 2006-04-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528488848 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Madigan Army Medical Ctr 9040, Jackson Ave, Tacoma, WA 98431-1100 | 2014-04-25 |
| 1518387836 | Naval Health Clinic Oak Harbor | Military/U.S. Coast Guard Pharmacy | Naval Hospital Oak Hbr 3475 N Saratoga St, Oak Harbor, WA 98278-8800 | 2014-04-25 |
| 1801195110 | 92 Medical Group/sgsl | Military/U.S. Coast Guard Pharmacy | 6955 22nd Ave Ne, # 3401, Moses Lake, WA 98837-3288 | 2011-03-25 |
| 1316243744 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | 10507 156th St E, Suite 112, Puyallup, WA 98374-9361 | 2011-02-02 |
| 1992804033 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 2202, Ft Lewis, WA 98433 | 2006-09-22 |
| 1609975747 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 9040a, Tacoma, WA 98431-0001 | 2006-09-22 |
| 1336248475 | Pt Angeles Uscg Phcy | Military/U.S. Coast Guard Pharmacy | Ediz Hook Rd, Port Angeles, WA 98362 | 2006-09-22 |
| 1619076650 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-09-22 |
| 1518066653 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 11582 17th and C St, Madigan Army Medical Ctr, Norr Fort Lewis, WA 98433 | 2006-09-22 |
| 1043317803 | Naval Hospital Bremerton | Military/U.S. Coast Guard Pharmacy | 2050 Barb St Ste A, Silverdale, WA 98315 | 2006-09-20 |
| Find all providers with the same taxonomy | ||||
| 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.