23RD MEDICAL GROUP (NPI# 1417362211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417362211 |
| Entity Type | Organization |
| Organization Name | 23RD MEDICAL GROUP |
| Other Organization Name | DOD MOODY EPHCY |
| Practice Address |
3278 Mitchell Blvd Moody Afb GA 31699-1500 |
| Mailing Address |
23 Rd Medical Group 3278 Mitchell Blvd Moody Afb GA 31699-1500 |
| Practice Telephone | 2292573221 |
| Practice Fax Number | 2292572345 |
| Mailing Telephone | 2292573221 |
| Mailing Fax Number | 2292572345 |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2016-02-08 |
| 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 | 2146570 | 01 |
| Other Name | Type Code |
|---|---|
| DoD MOODY ePhcy | Doing Business As Name - 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 | 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 |
|---|---|---|---|---|
| 1316907744 | 23 Mdg | Military/U.S. Coast Guard Pharmacy | 3278 Mitchell Blvd, Moody Afb, GA 31699-1500 | 2006-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023378403 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1100 Brookstone Centre Pkwy Rm 128, Columbus, GA 31904-4577 | 2012-05-21 |
| 1477811149 | Winn - Third Party Insurance | Military/U.S. Coast Guard Pharmacy | Bldg 8435, 306 Vanguard Road, Ft Stewart, GA 31314 | 2012-05-01 |
| 1992009401 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 6998 Old Cusseta Rd Bldg 4202, Fort Benning, GA 31905-5431 | 2010-12-28 |
| 1427131432 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | 29709 B Street, Fort Gordon, GA 30905-5741 | 2006-10-23 |
| 1790875029 | Winn-third Party Insurance | Military/U.S. Coast Guard Pharmacy | Hunter Af Bldg, Bldg 1450, Savannah, GA 31409 | 2006-10-16 |
| 1457450066 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Bldg 366, Ft Macpherson, GA 30330-5000 | 2006-09-21 |
| 1497854160 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | East Hospital Rd, Bldg 300 Rm 2c22, Ft Gordon, GA 30905 | 2006-09-21 |
| 1649379314 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Marne Rd Bldg 9200, Ft Benning, GA 31905 | 2006-09-21 |
| 1548369150 | Martin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Marne Rd Bldg 9230, Ft Benning, GA 31905 | 2006-09-21 |
| 1215036983 | Eisenhower Army Medical Center | Military/U.S. Coast Guard Pharmacy | Avenue B Bldg 29709, Mark Connelly Health Clinic, Ft Gordon, GA 30905 | 2006-09-21 |
| Find all providers with the same taxonomy | ||||
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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.