49TH MEDICAL GROUP (NPI# 1356755185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356755185 |
| Entity Type | Organization |
| Organization Name | 49TH MEDICAL GROUP |
| Other Organization Name | DOD HOLLOMAN EPHCY |
| Practice Address |
280 1st St Bldg 15 Holloman Afb NM 88330-8273 |
| Mailing Address |
49th Medical Group Baldwin Herman S II 280 1st Street Holloman Afb NM 88330-8273 |
| Practice Telephone | 5755720524 |
| Practice Fax Number | 5755725781 |
| Mailing Telephone | 5755720524 |
| Mailing Fax Number | 5755725781 |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2015-06-18 |
| 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 | 2146416 | 01 |
| Other Name | Type Code |
|---|---|
| DoD HOLLOMAN ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982701736 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Holloman Afb, NM 88330-8273 | 2006-09-20 |
| 1952374910 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Sgsr, Holloman Afb, NM 88330-8273 | 2006-02-09 |
| Street Address |
280 1ST ST BLDG 15 |
| City | HOLLOMAN AFB |
| State | NM |
| Zip Code | 88330-8273 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568606317 | Kimberly Dawn Jensen | Internal Medicine | 280 1st St Bldg 15, 49 Mdg Holloman Afb, Holloman Afb, NM 88330 | 2009-04-23 |
| 1376778407 | Jodi Clary | Military Health Care Provider | 280 1st St Bldg 15, Holloman Afb, NM 88330-8273 | 2009-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598312084 | Zachary James Smith | Pharmacist | 49th Medical Group 280 First Street, Holloman Afb, NM 88330 | 2019-08-20 |
| 1346776804 | Maxilea Isom | Behavior Technician | 2079 Eglin Ave Apt A, Holloman, Afb, NM 88330 | 2017-05-03 |
| 1932558665 | Courtney Davis | Day Training/Habilitation Specialist | 2228 La Luz Pkwy Unit A, Holloman Afb, NM 88330 | 2016-06-03 |
| 1568849255 | Ryan Abner | Registered Nurse | 49th Medical Building 17, Holloman Afb, NM 88330 | 2015-05-01 |
| 1710384292 | United States Air Force | Military Hospital | 49th Medical Bldg 17, Holloman Afb, NM 88330 | 2014-11-26 |
| 1174934764 | Jason Gordon | Social Worker | 1st Street Holloman Afb, Holloman Afb, NM 88330 | 2014-05-16 |
| 1649512807 | Philip Walker | Internal Medicine | 280 1st St, Holloman Afb, Alamogordo, NM 88330 | 2013-03-25 |
| 1275891889 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 551 4th Street, Bldg. 227, Holloman Afb, NM 88330 | 2012-05-02 |
| 1700042306 | Bettina Watkins | Family Medicine | 280 First St, Bldg 23, Holloman Afb, NM 88330 | 2008-08-03 |
| 1386849024 | Matthew Atwood | Social Worker | 200 First St., Bldg 17, Holloman Afb, NM 88330 | 2007-06-20 |
| Find all providers in zip 88330 | ||||
| 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 |
|---|---|---|---|---|
| 1982701736 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Holloman Afb, NM 88330-8273 | 2006-09-20 |
| 1952374910 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Sgsr, Holloman Afb, NM 88330-8273 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952716896 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | 1363 Aberdeen Road, White Sands Missile Range, NM 88002-5520 | 2014-06-30 |
| 1316253297 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Hawk Rd, Rm 9503-11, Chaparrel, NM 88021 | 2010-08-30 |
| 1780783134 | William Beaumont Army Medical | Military/U.S. Coast Guard Pharmacy | Aberdeen Ave, Bldg 1363, White Sand Missile Range, NM 88002 | 2006-09-22 |
| 1962501312 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | Gibson Blvd Bldg 20167, Albuquerque, NM 87108 | 2006-09-22 |
| 1871692228 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103-5009 | 2006-09-22 |
| 1417356072 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W D L Ingram Blvd, Cannon Afb, NM 88103-5103 | 2014-08-20 |
| 1740694553 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2014-06-19 |
| 1023172772 | Cannon Refill Phcy | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103 | 2006-12-20 |
| 1073610820 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 2050a 2nd St Se, Kirtland Afb, NM 87117-5524 | 2006-09-20 |
| 1285606384 | 27th Medical Group | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave, 27 Mdss Sgsr, Cannon Afb, NM 88103-5009 | 2006-02-02 |
| Find all providers with the same taxonomy | ||||
| City | HOLLOMAN AFB |
| Zip Code | 88330 |
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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.