633D MEDICAL GROUP (NPI# 1609859891) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609859891 |
| Entity Type | Organization |
| Organization Name | 633D MEDICAL GROUP |
| Other Organization Name | 1ST MEDICAL GROUP |
| Practice Address |
77 Nealy Ave Langley Afb VA 23665-2040 |
| Practice Telephone | 7577646807 |
| Practice Fax Number | 7577640821 |
| Mailing Telephone | 7577646807 |
| Mailing Fax Number | 7577640821 |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2014-03-03 |
| Authorized Official Name | THERESA MARIE MITCHELL (AF 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 | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities | ||
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| Y | 2865M2000X |
Military Hospital Specialization: Military General Acute Care Hospital |
Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | NCPDP | 4834722 | 01 |
| VA | BCBS | 000686 | 01 |
| Other Name | Type Code |
|---|---|
| 1st Medical Group | Former Legal Business Name - Organization |
| Street Address |
77 NEALY AVE |
| City | LANGLEY AFB |
| State | VA |
| Zip Code | 23665-2040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568096634 | Angela Rene Tuckett | Registered Nurse | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2020-02-27 |
| 1639729106 | Michael C Etheredge II | Military Health Care Provider | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2019-09-17 |
| 1588123962 | Lynzy Star Lee | Military Health Care Provider | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2019-03-15 |
| 1720562531 | Alexander Isaac Benavidez | Military Health Care Provider | 77 Nealy Ave, Langley Afb, VA 23665-2005 | 2018-09-18 |
| 1033516257 | Corey Lee Czajka | Emergency Medical Technician, Basic | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2014-12-03 |
| 1285054569 | Kristen E Spratt | Internal Medicine | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2014-04-24 |
| 1750700837 | Christopher Gurries | Dentist | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2014-04-16 |
| 1093153447 | Steven Kyle Hammond I | Military Health Care Provider | 77 Nealy Ave, 633d Mdg, Langley Afb, VA 23665-2040 | 2013-06-07 |
| 1215277454 | Jason Kieffer | Physician Assistant | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2013-02-26 |
| 1295074714 | Ashley Nicole Abbott | Military Health Care Provider | 77 Nealy Ave, Langley Afb, VA 23665-2040 | 2013-02-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982228938 | Mai Stern | Student in an Organized Health Care Education/Training Program | Langley Afb Dental Clinic, Hampton, VA 23665 | 2020-06-05 |
| 1386273449 | Nicholas Thomas Nelson | Military Health Care Provider | 633d Medical Group, 76 Nealy Ave, Building #92, Apo, AA 23665 | 2020-04-02 |
| 1316574809 | Kimberly C Easterling | Student in an Organized Health Care Education/Training Program | 76 Nealy Avenue, Joint Base Langley-eustis, Hampton, VA 23665 | 2020-03-24 |
| 1851950026 | Erin Leigh Baldridge | Dentist | Joint Base Langley Eustis Dental Clinic, 76 Nealy Ave, Apo, AA 23665 | 2019-06-11 |
| 1669950739 | Anthony Interrante IIi | Nurse Practitioner | Usaf Hospital Langley, 77 Nealy Avenue, Hampton, VA 23665 | 2018-08-01 |
| 1588189310 | Stacey Marie Jackson | Psychologist | 11 Nealy Blvd, Hampton, VA 23665 | 2017-08-14 |
| 1285062216 | Michael John Vietti | Physician Assistant | 633 Mdg 77 Nealy Ave, Yorktown, VA 23665 | 2013-10-30 |
| 1396182234 | Micaela Jane Dagucon | General Practice | 633d Mdg/sghc, 77 Nealy Avenue, Joint Base Langley-eustis, VA 23665 | 2013-06-02 |
| 1912212051 | Michele Leigh Shirley | Pharmacist | 633d Medical Group Hospital, 77 Nealy Avenue, Building 257, Joint Base Langley-eustis, VA 23665 | 2010-08-13 |
| 1497915219 | Stephen Warren Porter | Dentist | 76 Nealy Ave, 1st Dental Squadron/sgd, Langley Air Force Base, VA 23665 | 2008-06-16 |
| Find all providers in zip 23665 | ||||
| Taxonomy Code | 2865M2000X |
| Grouping | Hospitals |
| Classification | Military Hospital |
| Specialization | Military General Acute Care Hospital |
| A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in "fixed" facilities, primarily for DoD beneficiaries. Entity is Defense Health Program (DHP) funded. A "fixed" facility is a non-temporary, non-deployed facility usually used for health care services. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes those services and institutional costs usually included in a Diagnosis Related Group as well as "pass-through" items. |
| Notes: [1/1/2005: title modified, definition added] |
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|---|---|---|---|---|
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| 1083782874 | Naval Medical Center Portsmouth | Military Hospital | 411 Granby St Apt 48, Norfolk, VA 23510-1935 | 2006-12-01 |
| 1699876896 | Nmcp | Military Hospital | 6200 John Paul Jone Blvd, Portsmouth, VA 23704 | 2006-09-26 |
| 1538570692 | Dfas-cl/jflp | Military Hospital | 9300 Dewitt Loop, Fort Belvoir, VA 22060-5285 | 2014-05-12 |
| 1275808321 | Veterans Administration Medical Center | Military Hospital | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2012-03-21 |
| 1053559724 | Roy Anthony Pinedo | Military Hospital | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2009-02-03 |
| 1851469241 | Naval Medical Center Portsmouth | Military Hospital | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2006-12-01 |
| 1932276664 | Naval Medical Center Portsmouth | Military Hospital | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2006-11-29 |
| 1255380697 | Naval Medical Center Portsmouth | Military Hospital | 620 John Paul Jones Circle, Portsmouth, VA 23708-2197 | 2006-05-10 |
| Find all providers with the same taxonomy | ||||
| City | LANGLEY AFB |
| Zip Code | 23665 |
Please comment or provide details below to improve the information on 633D MEDICAL GROUP.
| 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.