66 MDSS-SGSR (NPI# 1508831553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508831553 |
| Entity Type | Organization |
| Organization Name | 66 MDSS-SGSR |
| Other Organization Name | HANSCOM MTF |
| Practice Address |
90 Vandenberg Dr Bldg 1900 Hanscom Afb MA 01731-2104 |
| Practice Telephone | 7813771770 |
| Practice Fax Number | 7813779840 |
| Mailing Telephone | 7813771770 |
| Mailing Fax Number | 7813779840 |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2014-02-18 |
| 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 | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | NCPDP | 22-38029 | 01 |
| Other Name | Type Code |
|---|---|
| Hanscom MTF | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760581185 | 66 Mdss-sgsr | Military/U.S. Coast Guard Pharmacy | 90 Vandenberg Dr Bldg 1900, Hanscom Afb, MA 01731-2104 | 2006-09-22 |
| 1649684473 | 66 Mdss-sgsr | Military/U.S. Coast Guard Pharmacy | 90 Vandenberg Dr Bldg 1900, Hanscom Afb, MA 01731-2104 | 2014-06-19 |
| Street Address |
90 VANDENBERG DR BLDG 1900 |
| City | HANSCOM AFB |
| State | MA |
| Zip Code | 01731-2104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194719476 | George Charles Hludzik | Dentist | 90 Vandenberg Dr, 66 Mds (afmc), Hanscom Afb, MA 01731-2104 | 2005-09-01 |
| 1598005225 | John David Gerhauser | Dentist | 90 Vandenberg Dr, Bldg 1900, 66 Mds, Hanscom Afb, MA 01731 | 2013-02-16 |
| 1376816462 | Ryan R Gustafson | Dentist | 90 Vandenberg Dr, 66 Mds (afmc), Hanscom Afb, MA 01731-2104 | 2012-02-20 |
| 1831486554 | James Michael Medeiros | General Practice | 90 Vandenberg Dr, 66 Mds (afmc), Hanscom Afb, MA 01731-2104 | 2011-07-01 |
| 1629386172 | Manisa Bulsara | Pharmacist | 90 Vandenberg Dr, 66 Mds, Hanscom Afb, MA 01731-2104 | 2010-09-17 |
| 1538476312 | Timothy Joseph Pappalardo | Social Worker | 90 Vandenberg Dr, 66 Mds (afmc), Hanscom Afb, MA 01731-2104 | 2010-09-01 |
| 1770898751 | Bryan Russell Katz | Dentist | 90 Vandenberg Dr, 66 Mds (afmc), Hanscom Afb, MA 01731-2104 | 2010-08-13 |
| 1124348008 | Brayden Tyler Bennett | Pharmacist | 90 Vandenberg Dr, Hanscom Afb, MA 01731-2104 | 2010-06-02 |
| 1033432034 | Matthew Robert Nicoli | Social Worker | 90 Vandenberg Dr, 66 Mds (afmc), Hanscom Afb, MA 01731-2104 | 2010-03-04 |
| 1154653749 | Sang Ngo | Pharmacist | 90 Vandenberg Dr, Hanscom Afb, MA 01731-2104 | 2010-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386114171 | Aletha Juah Thomas | Nurse's Aide | 1 Freedom Cir, Hanscom Afb, MA 01731 | 2018-12-05 |
| 1730609793 | Christopher M. Congemi | Dentist | 66mds (afmc), 90 Vandenberg Dr, Bldg 1900, Hanscom Afb, MA 01731 | 2017-06-21 |
| 1184011322 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 100 Elgin St, Bldg 1709 B, Hanscom Afb, MA 01731 | 2015-04-24 |
| 1578822912 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | Hanscom Afb, Building 1709, Bedford, MA 01731 | 2012-05-04 |
| 1215099858 | Paul R. Rivest | Psychologist | 66th Mdg Sgoh, Hanscom Afb, MA 01731 | 2006-12-13 |
| 1497837843 | Mara Salis | Social Worker | 2 Eglin St, Hanscom Afb, MA 01731 | 2006-10-19 |
| 1790749398 | Lakshmi Kona | Internal Medicine | 1609 Eglin Street, Hanscon Afb, MA 01731 | 2006-04-12 |
| 1245210715 | Jay Scott Cloutier | Physical Therapist | 66 Mdg/sgo, 90 Vandeberg Ave, Hanscom Afb, MA 01731 | 2006-01-19 |
| 1972589828 | Aron R. Potter | Psychologist | 90 Vandenberg Drive, Bldg 1900 66 Mds (afmc), Hanscom Afb, MA 01731 | 2005-12-21 |
| 1730160938 | Mohammed Fuad | Physician Assistant | 66 Mds (afmc), 90 Vandenberg Dr. Bldg. 1900, Hanscom Afb, MA 01731 | 2005-11-07 |
| Find all providers in zip 01731 | ||||
| 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 |
|---|---|---|---|---|
| 1205957982 | Uscg | Clinic/Center | 5439 A Lemay Ave., Buzzards Bay, MA 02542 | 2007-04-02 |
| 1578648093 | Uscg Isc Boston | Clinic/Center | 427 Commercial Street, Boston, MA 02109 | 2006-10-25 |
| 1225243140 | Keller Army Community Hospital | Clinic/Center | 42 Kansas St, Soldier Service Center, Natick, MA 01760-2642 | 2007-05-14 |
| 1093835977 | Us Coast Guard | Clinic/Center | 5201 Lee Rd, Buzzards Bay, MA 02542-1313 | 2007-04-02 |
| City | HANSCOM AFB |
| Zip Code | 01731 |
Please comment or provide details below to improve the information on 66 MDSS-SGSR.
| 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.