355TH MEDICAL GROUP SGSL


Address: 2714 Bola Ave, Tucson, AZ 85707
Phone: 5202283019

355TH MEDICAL GROUP SGSL (NPI# 1205935244) 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) 1205935244
Entity Type Organization
Organization Name 355TH MEDICAL GROUP SGSL
Other Organization Name DAVISMON SATL PHCY
Practice Address 2714 Bola Ave
Tucson
AZ 85707
Mailing Address C O Staff Sgt Blueford
4175 S Alamo Ave
Davis Monthan Afb
AZ 85707-6097
Practice Telephone 5202283019
Practice Fax Number 5202287259
Mailing Telephone 5202283019
Mailing Fax Number 5202287259
Enumeration Date 2006-09-22
Last Update Date 2016-02-12
Authorized Official Name HECTOR MORALES (CHIEF DHA PASS)
Authorized Official Telephone 2105366650
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 332000000X Military/U.S. Coast Guard Pharmacy Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
PK 1990502 01

Other Provider/Organization Names

Other Name Type Code
DAVISMON SATL PHCY Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1093814154 355th Medical Group Sgsl Military/U.S. Coast Guard Pharmacy 4175 S Alamo Ave, Davismonthan Afb, Tucson, AZ 85707-4402 2006-09-22

Office Location

Street Address 2714 BOLA AVE
City TUCSON
State AZ
Zip Code 85707

Providers in the same zip code

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 Information

Taxonomy Code 332000000X
Grouping Suppliers
Classification Military/U.S. Coast Guard Pharmacy

Taxonomy Definition

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]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1093814154 355th Medical Group Sgsl Military/U.S. Coast Guard Pharmacy 4175 S Alamo Ave, Davismonthan Afb, Tucson, AZ 85707-4402 2006-09-22
1245210384 355 Mdg Military/U.S. Coast Guard Pharmacy 4175 S Alamo Ave, Tucson, AZ 85707-6097 2006-01-17

Providers in the same taxonomy and state

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
Find all providers with the same taxonomy

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City TUCSON
Zip Code 85707

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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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