14TH MEDICAL GROUP (NPI# 1487630356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487630356 |
| Entity Type | Organization |
| Organization Name | 14TH MEDICAL GROUP |
| Practice Address |
201 Independence Suite 101 Columbus MS 39710-5300 |
| Practice Telephone | 6624342159 |
| Practice Fax Number | 6624342242 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2014-08-08 |
| Authorized Official Name | THERESA M. MITCHELL (AIR FORCE UNIFORM BUSINESS OFFICE) |
| 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 |
|---|---|---|---|
| MS | NCPDP | 2520179 | 01 |
| Street Address |
201 INDEPENDENCE SUITE 101 |
| City | COLUMBUS |
| State | MS |
| Zip Code | 39710-5300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811993843 | Cynthia Barrett | Social Worker | 201 Independence, Columbus, MS 39710-5300 | 2005-06-23 |
| 1346804531 | Caley Kropp | Student in an Organized Health Care Education/Training Program | 201 Independence, Columbus, MS 39710-5300 | 2019-04-24 |
| 1932696713 | James Tyler Bates | Family Medicine | 201 Independence, Columbus, MS 39710 | 2018-04-17 |
| 1497261051 | Gregory Correale | Pharmacist | 201 Independence, Columbus, MS 39710-5300 | 2017-12-19 |
| 1235580465 | Clare Weitz | Pharmacist | 201 Independence, Suite 2255, Columbus, MS 39710-5300 | 2016-06-29 |
| 1144679994 | Faga Samdumu | Pharmacist | 201 Independence, Columbus, MS 39710-5300 | 2016-06-11 |
| 1972964591 | Lauren Beers | Physical Therapist | 201 Independence, Columbus, MS 39710 | 2016-03-09 |
| 1780081026 | Anna Friscia | Registered Nurse | 201 Independence, Columbus, MS 39710-5300 | 2014-12-02 |
| 1992117378 | Jennifer Bryant Williams | Social Worker | 201 Independence, Columbus, MS 39710 | 2014-05-20 |
| 1891105466 | Robin Thompson | Registered Nurse | 201 Independence, Columbus, MS 39710-5300 | 2014-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558653063 | Steven Thomas Fosmire | Preventive Medicine | 14th Medical Group, 201 Independence Dr., Ste 2255, Columbus Afb, MS 39710 | 2011-05-03 |
| 1457311573 | Benjamin Jordan Franklin | Optometrist | 14 Medical Group, 201 Independence Dr Ste 235, Columbus Afb, MS 39710 | 2006-03-24 |
| 1396713194 | Kirk Tracy Moss | Family Medicine | 14th Mdg, 201 Independence Dr, Columbus Afb, MS 39710 | 2006-03-09 |
| 1659367266 | Paul H Nelson | Family Medicine | 201 Independence Dr, 14th Medical Group Ste 235, Columbus Afb, MS 39710 | 2005-09-20 |
| 1467447201 | James Henry Heriot | Internal Medicine | 201 Independence Drive, 14th Medical Group/sgoq, Columbus Afb, MS 39710 | 2005-09-19 |
| 1699372938 | Stacie Lynn Penkova | Pharmacist | 14th Medical Group, 201 Independence Drive, Columbus Afb, MS 39710 | 2020-10-08 |
| 1558740019 | William Jennings Amador | Family Medicine | 201 Independence Drive, 14th Medical Group, Columbus Afb, MS 39710 | 2015-05-29 |
| 1225457534 | Kenneth Richard Taylor | Preventive Medicine | 14th Medical Group, 201 Independence Drive, Columbus Afb, MS 39710 | 2014-04-15 |
| 1437414281 | Valerie Ayana Brennan | Social Worker | 14th Medical Group, 201 Independence Drive, Columbus, MS 39710 | 2012-07-09 |
| 1477845261 | Richard Joseph Levitre | Psychiatry & Neurology | 14th Medical Group 201 Independence Drive, Columbus, MS 39710 | 2011-05-11 |
| Find all providers in zip 39710 | ||||
| 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 |
|---|---|---|---|---|
| 1750584363 | Eisenhower Army Medical Center | Clinic/Center | 1450 14th St, Hattiesburg, MS 39407-0001 | 2007-06-10 |
| 1104031194 | Eisenhower Army Medical Center | Clinic/Center | 1001 Hardy St, Hattiesburg, MS 39401-4165 | 2007-05-11 |
| 1609076033 | Branch Medical Clinic Meridian | Clinic/Center | 1801 Fuller Rd, Meridian, MS 39309-5106 | 2007-07-24 |
| 1275733644 | Branch Medical Clinic Gulfport | Clinic/Center | 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2007-07-23 |
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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.