90TH MEDICAL GROUP-UNITED STATES AIR FORCE (NPI# 1609859826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609859826 |
| Entity Type | Organization |
| Organization Name | 90TH MEDICAL GROUP-UNITED STATES AIR FORCE |
| Other Organization Name | FE WARREN AFB |
| Practice Address |
6900 Alden Dr Fe Warren Afb WY 82005-3906 |
| Practice Telephone | 3077735674 |
| Practice Fax Number | 3077736574 |
| Mailing Telephone | 3077735674 |
| Mailing Fax Number | 3077736574 |
| Enumeration Date | 2005-11-22 |
| 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 | 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 |
|---|---|---|---|
| WY | NCPDP | 52-03625 | 01 |
| Other Name | Type Code |
|---|---|
| FE Warren AFB | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578979688 | 90th Medical Group-united States Air Force | Military/U.S. Coast Guard Pharmacy | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2014-07-09 |
| Street Address |
6900 ALDEN DR |
| City | FE WARREN AFB |
| State | WY |
| Zip Code | 82005-3906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457990863 | Vivian Colette Tran | Pharmacist | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2020-01-02 |
| 1275096737 | Richard K Newman | Student in an Organized Health Care Education/Training Program | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2019-04-11 |
| 1952806069 | Jodi Lynn Keithley | Dietitian, Registered | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2018-03-29 |
| 1437675949 | Thomas Charles Ingersoll Jr. | Physician Assistant | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2017-08-16 |
| 1730619446 | Lauren Joann Redlinger | Family Medicine | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2017-06-14 |
| 1427421312 | Rebecca Dawn Ishola | Registered Nurse | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2015-11-02 |
| 1679953640 | Mary Frances Macleod | Pediatrics | 6900 Alden Dr, Fe Warren Afb, WY 82005 | 2015-06-04 |
| 1497144612 | Kelly Smerling | Nurse Practitioner | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2015-01-12 |
| 1578979688 | 90th Medical Group-united States Air Force | Military/U.S. Coast Guard Pharmacy | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2014-07-09 |
| 1407289069 | James Henry Barry Jr. | Pediatrics | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2013-08-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285250597 | Brittany Corrin Souder | Military Health Care Provider | 1600 Aldene Drive, Fe Warren Afb, WY 82005 | 2020-06-23 |
| 1093368110 | Aaron Michael Keating | Student in an Organized Health Care Education/Training Program | Mental Health Clinic, 90th Omrs, Fe Warren Clinic, Fe Warren Afb, WY 82005 | 2019-07-17 |
| 1477643823 | Paul Hoon Kim | Dentist | 90 Mdos, 6900 Alden Dr, F.e. Warren Afb, WY 82005 | 2006-10-14 |
| 1568495315 | Joseph Myles Simpson, Jr. | Dentist | F E Warren Air Force Base Dental Clinic, 6900 Alden Drive, Cheyenne, WY 82005 | 2006-07-07 |
| 1306864632 | Lisa Sung Eun Lee | Pharmacist | 6900 Alden Drive, Fe Warren Afb, WY 82005 | 2006-07-17 |
| 1992957252 | Perala Enterprises, LLC | Eyewear Supplier (Equipment, not the service) | 6207 Missile Dr, Building 722, Ft Warren Afb, WY 82005-2407 | 2008-10-17 |
| 1972157808 | James Turvy | Dentist | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-2945 | 2019-07-29 |
| 1245478676 | Denise E Campbell | Nutritionist | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-3906 | 2009-01-22 |
| 1255837332 | Robert Usher Wright Jr. | General Practice | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-3906 | 2018-04-05 |
| 1396018982 | Ryan Christopher Reynolds | Pharmacist | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-3906 | 2012-02-14 |
| Find all providers in zip 82005 | ||||
| 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] |
| City | FE WARREN AFB |
| Zip Code | 82005 |
Please comment or provide details below to improve the information on 90TH MEDICAL GROUP-UNITED STATES AIR FORCE.
| 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.