US ARMY HEALTH CLINIC (NPI# 1497702591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497702591 |
| Entity Type | Organization |
| Organization Name | US ARMY HEALTH CLINIC |
| Other Organization Name | OHC DUGWAY PROVING GROUND |
| Practice Address |
5116 Kister Ave Rm #119 Dugway UT 84022-1097 |
| Mailing Address |
5116 Kister Ave Attn: Msa Office Dugway UT 84022-1097 |
| Practice Telephone | 4358313313 |
| Practice Fax Number | 4358313360 |
| Mailing Telephone | 4358313313 |
| Mailing Fax Number | 4358313360 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2015-11-17 |
| Authorized Official Name | ELIZABETH BURLINGAME (UBO MANAGER) |
| Authorized Official Telephone | 7195267291 |
| Is Organization Subpart | Y |
| Parent Organization Name | EVANS ARMY COMMUNITY HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP | 4609307 | 01 | |
| MEDCO | AN2598588 | 01 |
| Other Name | Type Code |
|---|---|
| OHC DUGWAY PROVING GROUND | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952854648 | Us Army Health Clinic | Clinic/Center | Bldg 2669 West Regimental Road, Ft Mccoy, WI 54656-5229 | 2016-07-28 |
| 1427262518 | Us Army Health Clinic | Clinic/Center | Tooele Army Depot, Bldg 400, Tooele, UT 84074 | 2007-05-09 |
| 1689773707 | Us Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 5116 Kister Avenue, Room #119, Dugway, UT 84022 | 2006-09-22 |
| Street Address |
5116 KISTER AVE RM #119 |
| City | DUGWAY |
| State | UT |
| Zip Code | 84022-1097 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093906224 | Christopher Mcguire | Preventive Medicine | Kister Ave, Building 5166, U.S. Army Health Clinic, Dugway, UT 84022 | 2007-08-05 |
| 1689773707 | Us Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 5116 Kister Avenue, Room #119, Dugway, UT 84022 | 2006-09-22 |
| 1346253945 | Susanne Christine Thobe | Preventive Medicine | Bldg 5116 Kister Avenue, Dugway, UT 84022 | 2006-08-14 |
| 1558381368 | Stephen A. Briles | Registered Nurse | 5236 Valdez Circle, Building 5236, Us Army Health Clinic - Dugway Proving Ground, Dugway, UT 84022 | 2006-07-21 |
| 1578531935 | Clark Mcdonough | Internal Medicine | 5236 Valdez Circle, Dugway, UT 84022 | 2006-03-10 |
| 1487621629 | Susan Lohnes | Social Worker | 5236 Valdez Cir, Dugway, UT 84022-1049 | 2006-03-07 |
| 1568439156 | William C Otto | Preventive Medicine | 629 Coyote Cv, A, Dugway, UT 84022-1079 | 2006-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093906224 | Christopher Mcguire | Preventive Medicine | Kister Ave, Building 5166, U.S. Army Health Clinic, Dugway, UT 84022 | 2007-08-05 |
| 1689773707 | Us Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 5116 Kister Avenue, Room #119, Dugway, UT 84022 | 2006-09-22 |
| 1346253945 | Susanne Christine Thobe | Preventive Medicine | Bldg 5116 Kister Avenue, Dugway, UT 84022 | 2006-08-14 |
| 1558381368 | Stephen A. Briles | Registered Nurse | 5236 Valdez Circle, Building 5236, Us Army Health Clinic - Dugway Proving Ground, Dugway, UT 84022 | 2006-07-21 |
| 1578531935 | Clark Mcdonough | Internal Medicine | 5236 Valdez Circle, Dugway, UT 84022 | 2006-03-10 |
| 1487621629 | Susan Lohnes | Social Worker | 5236 Valdez Cir, Dugway, UT 84022-1049 | 2006-03-07 |
| 1568439156 | William C Otto | Preventive Medicine | 629 Coyote Cv, A, Dugway, UT 84022-1079 | 2006-03-02 |
| 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 |
|---|---|---|---|---|
| 1427262518 | Us Army Health Clinic | Clinic/Center | Tooele Army Depot, Bldg 400, Tooele, UT 84074 | 2007-05-09 |
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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.