75TH MEDICAL GROUP SGSB (NPI# 1619381449) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619381449 |
| Entity Type | Organization |
| Organization Name | 75TH MEDICAL GROUP SGSB |
| Other Organization Name | DOD HILL EPHCY |
| Practice Address |
5845 E Ave Bldg 412 Hill Afb UT 84056-5303 |
| Mailing Address |
75th Medical Group Sgsb 7321 11th St Bldg 570 Hill Afb UT 84056-5012 |
| Practice Telephone | 8015869530 |
| Practice Fax Number | 8015869890 |
| Mailing Telephone | 8015869530 |
| Mailing Fax Number | 8015869890 |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2015-06-18 |
| 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 | 2146308 | 01 |
| Other Name | Type Code |
|---|---|
| DoD HILL ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053473033 | 75th Medical Group Sgsb | Military/U.S. Coast Guard Pharmacy | 7321 Balmer St, Bldg 570, Hill Afb, UT 84056-5012 | 2006-12-15 |
| 1134228257 | 75th Medical Group Sgsb | Military/U.S. Coast Guard Pharmacy | 7321 Balmer St, Bldg 570, Hill Afb, UT 84056-5012 | 2006-09-22 |
| 1912971441 | 75th Medical Group Sgsb | Military/U.S. Coast Guard Pharmacy | 7321 11th St, Bldg 570, Hill Afb, UT 84056-5012 | 2006-02-13 |
| Street Address |
5845 E AVE BLDG 412 |
| City | HILL AFB |
| State | UT |
| Zip Code | 84056-5303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235613035 | Sahiba Bedi | Pharmacist | 5845 E Ave Bldg 412, Hill Afb, UT 84056-5303 | 2018-09-18 |
| 1467993907 | Tracy Amy Louie | Pharmacist | 5845 E Ave Bldg 412, Hill Afb, UT 84056-5303 | 2017-03-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629639885 | Brian A Silva | Physician Assistant | 7321 Balmer Street Bldg 570, Hill Air Force Base, UT 84056 | 2019-06-27 |
| 1245767045 | Keith Mele | Pharmacist | 7457 Weiner Street, Hill Air Force Base, UT 84056 | 2017-05-11 |
| 1235513540 | Joshua David Stumpf | Military Health Care Provider | 570 Balmer Street, Hill Afb, UT 84056 | 2015-07-16 |
| 1194107912 | Kelly Johnson | Social Worker | 75 Mdg, Mental Health Clinic, 7309 Balmer Street, Bldg 545, Hill Afb, UT 84056 | 2015-06-29 |
| 1831449156 | Curt G Martin | Dentist | 7321 Balmer, 75 Mdg, Hill Afb, UT 84056 | 2012-09-13 |
| 1811253222 | Tiffany Amber Brakefield | Psychologist | 7309 Balmer St Bldg 545, Hill Afb, UT 84056 | 2012-04-10 |
| 1982910907 | Peter Shigeki Frandsen | Dentist | 7321 Balmer Street Bldg #570, Hill Afb, 75th Mdg/sgd, Hill Afb, UT 84056 | 2010-08-27 |
| 1861625436 | Michael David Brewer | Family Medicine | 7321 Balmer Ave, Hill Afb, UT 84056 | 2009-08-31 |
| 1780838789 | Nisha Ray Baur | Pediatrics | Bldg 569 Hill Afb, Clearfield, UT 84056 | 2008-11-05 |
| 1629230669 | Elizabeth A. Sherlock | Psychologist | 75 Mdg/sghc, 7321 11th Street, Bldg. 570, Hill Afb, UT 84056 | 2008-07-01 |
| Find all providers in zip 84056 | ||||
| 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 |
|---|---|---|---|---|
| 1053473033 | 75th Medical Group Sgsb | Military/U.S. Coast Guard Pharmacy | 7321 Balmer St, Bldg 570, Hill Afb, UT 84056-5012 | 2006-12-15 |
| 1134228257 | 75th Medical Group Sgsb | Military/U.S. Coast Guard Pharmacy | 7321 Balmer St, Bldg 570, Hill Afb, UT 84056-5012 | 2006-09-22 |
| 1912971441 | 75th Medical Group Sgsb | Military/U.S. Coast Guard Pharmacy | 7321 11th St, Bldg 570, Hill Afb, UT 84056-5012 | 2006-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689773707 | Us Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 5116 Kister Avenue, Room #119, Dugway, UT 84022 | 2006-09-22 |
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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.