42ND MEDICAL GROUP SGSL (NPI# 1255430302) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255430302 |
| Entity Type | Organization |
| Organization Name | 42ND MEDICAL GROUP SGSL |
| Other Organization Name | MAXWELL MAIN PHCY42ND MDG |
| Practice Address |
330 S Twining St Bldg 760 Maxwell Afb AL 36112 |
| Practice Telephone | 3349536868 |
| Mailing Telephone | 3349536868 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-10-05 |
| 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 |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 1993811 | 01 |
| Other Name | Type Code |
|---|---|
| MAXWELL MAIN PHCY42ND MDG | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497854566 | 42nd Medical Group Sgsl | Pharmacy | Bldg 810 Gunter Annex, Maxwell Afb, AL 36112 | 2006-09-22 |
| Street Address |
330 S TWINING ST BLDG 760 |
| City | MAXWELL AFB |
| State | AL |
| Zip Code | 36112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841836970 | Alison Bees Thompson | Social Worker | 42nd Medical Group, 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2019-11-25 |
| 1881245967 | Grant M Golombeski | Military Health Care Provider | 300 S Twinning Dr., Apo, AA 36112 | 2019-09-20 |
| 1477015196 | Jennifer Marie Hudson | Counselor | Jennifer Hudson, 300 South Twining St Bldg 760, Maxwell Afb, AL 36112 | 2019-04-02 |
| 1255801049 | Jose Edwin Aviles | Military Health Care Provider | Kelly Street, Montgomery, AL 36112 | 2018-12-05 |
| 1306316963 | Lydia Price Beringer | Speech-Language Pathologist | 300 S. Twining Street 42 Nd Medical Group, Maxwell Afb, AL 36112 | 2018-11-27 |
| 1114431301 | Dean M Kot | Physician Assistant | Mxf, Kelly St, Apo, AA 36112 | 2017-11-27 |
| 1417353590 | Jamie Ellis | Social Worker | 300 S. Twining St. Bldg 760, Maxwell Afb, AL 36112 | 2014-11-17 |
| 1629419650 | Elias N Hydrick | Family Medicine | 300 S. Twining St., Bldg 760, Maxwell Afb, 42nd Medical Group, Montgomery, AL 36112 | 2013-07-06 |
| 1639454200 | Sharon Lewis | Pharmacist | 300 Southtwining St, Montgomery, AL 36112 | 2011-10-14 |
| 1104158518 | Sylvia Ann Newell | Dietitian, Registered | 50 W Ash St Bldg 841, Montgomery, AL 36112 | 2010-02-10 |
| Find all providers in zip 36112 | ||||
| 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 |
|---|---|---|---|---|
| 1346349495 | United States Army Aeromedical Center | Military/U.S. Coast Guard Pharmacy | Dustoff Ave Bldg 301, Ft Rucker, AL 36362-5333 | 2006-09-22 |
| 1982010351 | United States Army Aeromedical Center | Military/U.S. Coast Guard Pharmacy | 301 Andrews Avenue, Fort Rucker, AL 36362-5350 | 2014-07-07 |
| 1487068201 | Fox Army Health Center | Military/U.S. Coast Guard Pharmacy | 4100 Goss Rd Sw, Fox Army Health Center, Huntsville, AL 35809-0001 | 2014-06-19 |
| 1558549121 | United States Army Aeromedical Center | Military/U.S. Coast Guard Pharmacy | 5th Ave, Bldg 4405, Ft. Rucker, AL 36362-5333 | 2008-02-06 |
| 1164521217 | Fox Army Health Center | Military/U.S. Coast Guard Pharmacy | Usa Meddac, Bldg 4100 Goss Rd, Redstone Arsenal, AL 35809-7000 | 2006-09-22 |
| City | MAXWELL AFB |
| Zip Code | 36112 |
Please comment or provide details below to improve the information on 42ND MEDICAL GROUP SGSL.
| 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.