359TH MDG (NPI# 1306160973) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306160973 |
| Entity Type | Organization |
| Organization Name | 359TH MDG |
| Other Organization Name | RANDOLPH BX PHCY |
| Practice Address |
630 3rd St W Bldg 1068 Randolph Afb TX 78150-4804 |
| Mailing Address |
221 3rd St W Bldg 1040 Randolph Afb TX 78150-4800 |
| Practice Telephone | 2106526742 |
| Practice Fax Number | 2106523516 |
| Mailing Telephone | 2102218274 |
| Mailing Fax Number | 2102952567 |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2016-10-24 |
| 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 | 2124452 | 01 |
| Other Name | Type Code |
|---|---|
| RANDOLPH BX PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598862344 | 359th Mdg | Military/U.S. Coast Guard Pharmacy | 221 3rd St W Bldg 1040, Universal City, TX 78150-4800 | 2006-09-20 |
| Street Address |
630 3RD ST W BLDG 1068 |
| City | RANDOLPH AFB |
| State | TX |
| Zip Code | 78150-4804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770045833 | Erica Renae Guevara | Physician Assistant | 559 Medial Sq, 221 Third Street West Bldg. 1040, Jbsa-randolph Afb, TX 78150 | 2019-04-05 |
| 1457803868 | Emily Newman | Dietitian, Registered | 221 Third Street West, Bldg. 999 Ste 2, Joint Base San Antonio -randolph, TX 78150 | 2016-11-02 |
| 1922411677 | Amber Drewer | Military Health Care Provider | 3rd Street West Building 1040, Randolph Afb, TX 78150 | 2014-06-10 |
| 1144652975 | Josephine Kimberly Olsen | Family Medicine | 359 Mdos/mdg, Randolph Afb, TX 78150 | 2013-08-02 |
| 1609149681 | Lucky Lusterio | Preventive Medicine | 221 3rd St. W, Randolph Afb, TX 78150 | 2012-02-21 |
| 1417120569 | Joni Hodgson | General Practice | 221 3rd Street West, Jbsa Randolph, TX 78150 | 2008-04-09 |
| 1710095724 | Katherine Justen Adamson | Physician Assistant | 12th Medical Group, 221 3rd Street West, Randolph Air Force Base, TX 78150 | 2006-08-29 |
| 1811950090 | Lidia Stana Ilcus | Internal Medicine | 359 Mdg, 221 Third Street West, Randolph Afb, TX 78150 | 2006-04-10 |
| 1013970672 | David Hamilton | Social Worker | 12mdos/sgohf, Randolph Afb, TX 78150 | 2006-04-06 |
| 1962465526 | Robert Allan Briggs | Physical Therapist | Randolph Afb Clinic, 221 3rd St W, Randolph Afb, TX 78150 | 2006-04-06 |
| Find all providers in zip 78150 | ||||
| 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 |
|---|---|---|---|---|
| 1861800567 | 359 Medical Group | Military/U.S. Coast Guard Pharmacy | 221 3rd St W Bldg 1040, Randolph Afb, TX 78150-4800 | 2014-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710532510 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 7800 W Ih 10 Ste 235, San Antonio, TX 78230-4768 | 2019-08-08 |
| 1508364258 | Wilford Hall Medical Center | Military/U.S. Coast Guard Pharmacy | 25615 Us Highway 281 N Ste 215, San Antonio, TX 78258-7135 | 2018-01-29 |
| 1831502590 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 2401 Scott Rd, Brooke Army Medical Center, Fort Sam Houston, TX 78234 | 2014-06-10 |
| 1124431317 | Carl R. Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | 4250 Clear Creek Rd, Room 406, Fort Hood, TX 76544-5095 | 2014-06-05 |
| 1134479413 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Torch St Rm C101, Bldg 21227, Ft Bliss, TX 79916 | 2012-09-14 |
| 1053618546 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 6501 Fm 3009, Suite 210, Schertz, TX 78154 | 2011-02-17 |
| 1740580125 | Carl R Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | 458 W Highway 190, Town Square Shopping Center, Copperas Cove, TX 76522-3904 | 2010-11-01 |
| 1477853851 | Carl R Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | Market Heights Shopping Center 201 E., Central Texas Expressway, Harker Heights, TX 76548 | 2010-11-01 |
| 1891003000 | Carl R Darnall Amry Medical Center | Military/U.S. Coast Guard Pharmacy | 2245 761st Tank Bn, Bldg 2245, Fort Hood, TX 76544 | 2010-09-22 |
| 1962718726 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Haan Rd, Ste A-11 Bldg 1611, Ft Bliss, TX 79916 | 2010-08-31 |
| Find all providers with the same taxonomy | ||||
| City | RANDOLPH AFB |
| Zip Code | 78150 |
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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.