23 MDG (NPI# 1316907744) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316907744 |
| Entity Type | Organization |
| Organization Name | 23 MDG |
| Other Organization Name | MOODY AFB MTF |
| Practice Address |
3278 Mitchell Blvd Moody Afb GA 31699-1500 |
| Practice Telephone | 2292573041 |
| Practice Fax Number | 2292575528 |
| Mailing Telephone | 2292573041 |
| Mailing Fax Number | 2292575528 |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2014-03-06 |
| Authorized Official Name | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| 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 |
|---|---|---|---|
| GA | NCPDP | 1142784 | 01 |
| GA | ASSOCIATED PHARMACY NPI | 1689773350 | 01 |
| Other Name | Type Code |
|---|---|
| Moody AFB MTF | Other Name - Individual/Organization |
| Street Address |
3278 MITCHELL BLVD |
| City | MOODY AFB |
| State | GA |
| Zip Code | 31699-1500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811982903 | Yvette Guzman | Pediatrics | 3278 Mitchell Blvd, Moody Afb, Moody Afb, GA 31699-1500 | 2005-09-14 |
| 1578179958 | Lawanna Renee Barron | Social Worker | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2020-09-21 |
| 1831725381 | Bradley James Connahey | Military Health Care Provider | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2020-03-17 |
| 1477049781 | Andrew Glidewell | Physician Assistant | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2018-07-10 |
| 1215431309 | Taylor Montana Martin | Military Health Care Provider | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2018-03-22 |
| 1982120796 | Byron Reed | Military Health Care Provider | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2017-08-15 |
| 1568909091 | Bailey Holt | Military Health Care Provider | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2017-01-23 |
| 1770941254 | Ashley Patterson | Contractor | 3278 Mitchell Blvd, Building 900, Moody Afb, GA 31699-1500 | 2016-01-29 |
| 1982088340 | Sarah E Stone | Nurse Practitioner | 3278 Mitchell Blvd, Moody Afb, GA 31699-5529 | 2015-07-16 |
| 1427439165 | Armand Allkanjari | General Practice | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2015-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548771876 | Aldo Enrique Revilla | Psychologist | Bermiss Rd, Moody Afb, Valdosta, GA 31699 | 2017-10-13 |
| 1699903146 | Elizabeth L Fauber | Military Health Care Provider | 9551 Luke Street, Apo, AP 31699 | 2009-06-23 |
| 1063646230 | James Michael White | Military Health Care Provider | 3278 Mithell Blvd, Bldg. 900, Moody Afb, GA 31699 | 2009-05-04 |
| 1265415590 | Rosalie Andrea Castillo | Family Medicine | 347th Medical Group, 3278 Mitchell Blvd, Valdosta, GA 31699 | 2005-11-21 |
| 1902379555 | Amber Leigh Tordoff | Student in an Organized Health Care Education/Training Program | 23d Medical Group 3278 Mitchell Blvd, Building 900, Apo, AA 31699 | 2019-01-07 |
| 1083147367 | Jordan Robbins | Dentist | 23rd Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699 | 2017-04-04 |
| 1518364678 | Rachel Collins | Specialist/Technologist | 23 Mdos Sgoy, 3278 Mitchell Blvd, Moody Afb, GA 31699-0001 | 2014-12-04 |
| 1083988356 | Brock Allen Mcnabb | Social Worker | 23rd Medical Group 3278 Mitchell Blvd, Moody Afb, GA 31699-0001 | 2012-03-02 |
| 1760711162 | Christopher Wayne Daniels | Physician Assistant | 23 Medical Group, 3278 Mitchell Blvd, Moody A F B, GA 31699-0001 | 2009-12-14 |
| 1447487749 | Roong Robert Burket | Military Health Care Provider | 347 Oss Osm, Moody A F B, GA 31699-0001 | 2009-06-15 |
| Find all providers in zip 31699 | ||||
| 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 |
|---|---|---|---|---|
| 1275929770 | Winn-thrid Party Insurance | Clinic/Center | 952 William H. Wilson Ave, Fort Stewart, GA 31314 | 2015-04-10 |
| 1528454022 | Winn-thrid Party Insurance | Clinic/Center | 1746 William H. Wilson Ave, Fort Stewart, GA 31314 | 2015-04-10 |
| 1235442328 | Winn-thrid Party Insurance | Clinic/Center | 2451a Hwy 17, Station Shopping Center, Richmond Hill, GA 31324-6422 | 2010-07-19 |
| 1053624130 | Martin Army Community Hospital | Clinic/Center | 6976 Old Cusseta Rd, Harmony Church, Fort Benning, GA 31905-5431 | 2010-07-19 |
| 1063616266 | Martin Army Community Hospital | Clinic/Center | 9200 Mame Road, Fort Benning, GA 31905 | 2007-06-12 |
| 1417151788 | Winn-thrid Party Insurance | Clinic/Center | 306 Vanguard Road, Building 2115, Suite 100, Fort Stewart, GA 31314 | 2007-06-12 |
| 1588868848 | Eisenhower Army Medical Center | Clinic/Center | 320 Hospital Road, Fort Gordon, GA 30905 | 2007-06-12 |
| 1235333592 | Winn-thrid Party Insurance | Clinic/Center | 434 Vanguard Road, Fort Stewart, GA 31314 | 2007-06-12 |
| 1245434448 | Martin Army Community Hospital | Clinic/Center | 2622 Soldiers Plaza, Fort Benning, GA 31905 | 2007-06-12 |
| 1912101270 | Winn-thrid Party Insurance | Clinic/Center | 55 Pony Soldier Road, Building 253-s, Fort Stewart, GA 31314 | 2007-06-12 |
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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.