22ND MEDGP/SGSLA (NPI# 1639403090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639403090 |
| Entity Type | Organization |
| Organization Name | 22ND MEDGP/SGSLA |
| Other Organization Name | MCCONNEL SPO PHCY |
| Practice Address |
57950 Leavenworth St Mcconnell Afb KS 67221-3506 |
| Mailing Address |
2450 Stanley Rd Ste 208 Fort Sam Houston TX 78234-6108 |
| Practice Telephone | 3167594203 |
| Mailing Telephone | 2102218274 |
| Mailing Fax Number | 2102852567 |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2009-10-01 |
| Authorized Official Name | HECTOR MORALES (DEPUTY DIRECTOR OF PHARMACY OPS CTR) |
| Authorized Official Telephone | 2102218443 |
| Is Organization Subpart | Y |
| Parent Organization Name | 22ND MEDGP/SGSLA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| Other Name | Type Code |
|---|---|
| MCCONNEL SPO PHCY | Doing Business As Name - Organization |
| Street Address |
57950 LEAVENWORTH ST |
| City | MCCONNELL AFB |
| State | KS |
| Zip Code | 67221-3506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194712828 | Everett J Deleon | Family Medicine | 57950 Leavenworth St, Attn Credentials Manager, Mcconnell Afb, KS 67221-3506 | 2005-09-27 |
| 1073151023 | Arlington Dale Lindskog | Physical Therapist | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2019-12-19 |
| 1083264550 | Brianna Hope Slayback | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2019-09-17 |
| 1538729132 | Matthew Alan Duggan | Physician Assistant | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2019-06-17 |
| 1295212413 | Walter Steven Agudelo | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-07-20 |
| 1215425657 | Jordon L Jeans | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-05-01 |
| 1144721150 | Daniel Belgam | Student in an Organized Health Care Education/Training Program | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-02-24 |
| 1568960342 | Justine R Froude | Military Health Care Provider | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2018-01-26 |
| 1578919049 | Kathryn Rachel Kocher | Pediatrics | 57950 Leavenworth St, Mcconnell Afb, KS 67221 | 2016-05-13 |
| 1265817878 | Rachel M Gurley | Social Worker | 57950 Leavenworth St, 22 Mdos/ Sgow, Mcconnell Afb, KS 67221-3506 | 2015-07-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922528421 | Rose Lee Samples | Nurse Practitioner | 51950 Leavenworth St., Family Health Clinic 22 Mdg, Mcconnell Afb, KS 67221 | 2017-06-26 |
| 1114247913 | Dawn Marie Clifton | Nurse Practitioner | 57950 Leavenworth Ave Bldg 250, 22d Medical Group, Mcconnell Afb, KS 67221 | 2010-06-03 |
| 1467514489 | 22nd Medical Group | Pharmacy | 57590 Leavenworth Bldg 250, Mcconnell Afb, KS 67221 | 2006-12-15 |
| 1336182153 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | Derby Street, Building 352, Mcconnell Afb, KS 67221 | 2006-06-13 |
| 1962707067 | Melissa M Wendt | Physician Assistant | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221 | 2011-01-20 |
| 1922232271 | Richard Jimenez Rubi | Military Health Care Provider | 22 Mdg, Mcconnell Afb, KS 67221 | 2009-05-14 |
| 1871581306 | Joshua A Hartman | Emergency Medicine | 57950 Leavenworth St Bldg 248, Mcconnell Afb, KS 67221-3505 | 2005-10-10 |
| 1164052700 | Taylor Holloway | Family Medicine | 57950 Leavenworth St Bldg 250, Mcconnell Afb, KS 67221-3505 | 2020-01-23 |
| 1407296940 | Daniel Richard Galle | Optometrist | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221-3505 | 2013-06-28 |
| 1669969424 | Alesha Avis Heinz | Student in an Organized Health Care Education/Training Program | 57950 Leavenworth Street, Suite 4e1, Mcconnell Afb, KS 67221-3506 | 2018-04-17 |
| Find all providers in zip 67221 | ||||
| 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 |
|---|---|---|---|---|
| 1932421658 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 2210 Trooper Drive, Ft Riley, KS 66442 | 2010-02-22 |
| 1023330743 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 8072 Normandy Drive, Ft Riley, KS 66442 | 2010-02-22 |
| 1841352580 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Building 600, Ft Riley, KS 66442 | 2006-12-15 |
| 1316046949 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 600, Caisson Hill Road, Ft Riley, KS 66442 | 2006-09-21 |
| 1265814842 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 623 Southwind Drive, Junction City, KS 66441 | 2015-06-19 |
| 1740696095 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 600 Caisson Hill Rd, Fort Riley, KS 66442-7037 | 2014-07-08 |
| 1730593567 | Munson Army Health Center | Military/U.S. Coast Guard Pharmacy | 550 Pope Ave, Munson Army Health Center, Fort Leavenworth, KS 66027-2332 | 2014-06-19 |
| 1679637334 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Building 600, Ft Riley, KS 66442 | 2006-12-20 |
| 1245339878 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 650 Huebner Rd, Ft Riley, KS 66442 | 2006-09-21 |
| 1457458200 | Munson Army Health Center | Military/U.S. Coast Guard Pharmacy | 550 Pope Ave, Fort Leavenworth, KS 66027-2332 | 2006-09-20 |
| Find all providers with the same taxonomy | ||||
| City | MCCONNELL AFB |
| Zip Code | 67221 |
Please comment or provide details below to improve the information on 22ND MEDGP/SGSLA.
| 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.