MADIGAN ARMY MEDICAL CTR (NPI# 1619076650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619076650 |
| Entity Type | Organization |
| Organization Name | MADIGAN ARMY MEDICAL CTR |
| Other Organization Name | LEWIS MAIN PHCY |
| Practice Address |
Jackson Ave Bldg 9040a Tacoma WA 98431-0001 |
| Mailing Address |
Jackson Ave Bldg 9040a Attn Mchj-pd-msa Tacoma WA 98431-0001 |
| Practice Telephone | 2539682015 |
| Practice Fax Number | 2539686233 |
| Mailing Telephone | 2539686233 |
| Mailing Fax Number | 2102952567 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-03-29 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2110629 | 01 |
| Other Name | Type Code |
|---|---|
| LEWIS MAIN PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770975583 | Madigan Army Medical Ctr | Clinic/Center | Railroad Ave Bldg R3749, Tacoma, WA 98431-0001 | 2015-03-03 |
| 1528488848 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Madigan Army Medical Ctr 9040, Jackson Ave, Tacoma, WA 98431-1100 | 2014-04-25 |
| 1376974303 | Madigan Army Medical Ctr | Clinic/Center | 3 Rd Division Dr Bldg R3150, Tacoma, WA 98431-0001 | 2013-12-02 |
| 1588094213 | Madigan Army Medical Ctr | Clinic/Center | C St Bldg R1880, Tacoma, WA 98431-0001 | 2013-11-15 |
| 1043640774 | Madigan Army Medical Ctr | Clinic/Center | Railroad Ave Bldg R3742, Tacoma, WA 98431-0001 | 2013-11-15 |
| 1750719761 | Madigan Army Medical Ctr | Clinic/Center | 5 Th St Bldg 9025, Tacoma, WA 98431-0001 | 2013-10-30 |
| 1801152723 | Madigan Army Medical Ctr | Clinic/Center | 13815 8th St, Joint Base Lewis Mcchord, WA 98431-0001 | 2012-04-04 |
| 1316243744 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | 10507 156th St E, Suite 112, Puyallup, WA 98374-9361 | 2011-02-02 |
| 1851605356 | Madigan Army Medical Ctr | Clinic/Center | 15600 Meridan Ave, Sunrise Village Center, East Puyallup, WA 98374 | 2010-07-27 |
| 1881907822 | Madigan Army Medical Ctr | Clinic/Center | 3415 Pacific Ave Se, Suite D1, Olympia, WA 98501-2173 | 2010-07-20 |
| Street Address |
JACKSON AVE BLDG 9040A |
| City | TACOMA |
| State | WA |
| Zip Code | 98431-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083776090 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-12-15 |
| 1700948130 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-12-14 |
| 1528167566 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1336695535 | Jacqueline D Massouda | Dentist | Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 | 2016-08-28 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
| Find all providers in zip 98431 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528488848 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Madigan Army Medical Ctr 9040, Jackson Ave, Tacoma, WA 98431-1100 | 2014-04-25 |
| 1609975747 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 9040a, Tacoma, WA 98431-0001 | 2006-09-22 |
| 1780803593 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | 9040a Jackson Ave, Attn: Mchj-csa-u, Tacoma, WA 98431-0001 | 2007-04-24 |
| 1174685184 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 9040a, Tacoma, WA 98431-0001 | 2006-12-15 |
| 1083776090 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-12-15 |
| 1891857801 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 9040a, Tacoma, WA 98431-0001 | 2006-12-15 |
| 1700948718 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 9040a, Tacoma, WA 98431-0001 | 2006-12-15 |
| 1700948130 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-12-14 |
| 1528167566 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-09-22 |
| 1134226996 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | 9040a Jackson Ave, Tacoma, WA 98431-0001 | 2006-09-20 |
| Find all providers in TACOMA | ||||
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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.