47TH MEDICAL GROUP SGSL (NPI# 1679672893) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679672893 |
| Entity Type | Organization |
| Organization Name | 47TH MEDICAL GROUP SGSL |
| Other Organization Name | LAUGHLIN PHCY |
| Practice Address |
590 Mitchell Blvd Bldg 375 Laughlin Afb TX 78843-5242 |
| Practice Telephone | 8302986451 |
| Practice Fax Number | 8302986511 |
| Mailing Telephone | 8302986451 |
| Mailing Fax Number | 8302986511 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-03-28 |
| 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 | 2092681 | 01 |
| Other Name | Type Code |
|---|---|
| LAUGHLIN PHCY | Doing Business As Name - Organization |
| Street Address |
590 MITCHELL BLVD BLDG 375 |
| City | LAUGHLIN AFB |
| State | TX |
| Zip Code | 78843-5242 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205236544 | Luke Czer | Dentist | 590 Mitchell Blvd, Laughlin Afb, TX 78843-5242 | 2014-08-22 |
| 1639414949 | Yuwen Wang | Dentist | 590 Mitchell Blvd, Building 375, Laughlin Afb, TX 78843 | 2012-11-28 |
| 1730484809 | Jennifer Hofmann | Dietitian, Registered | 590 Mitchell Blvd, Laughlin Afb, TX 78843-5242 | 2011-01-20 |
| 1437167244 | Micheal H. Beto | Dentist | 590 Mitchell Blvd, Laughlin Afb, TX 78843-5244 | 2006-08-04 |
| 1992727077 | Robert Theodore Pohler | Pharmacist | 590 Mitchell Blvd, 47 Mdg/sgsap, Laughlin Afb, TX 78843 | 2006-07-24 |
| 1265404552 | Melinda Dawn Sams | Pharmacist | 590 Mitchell Blvd, 47 Mdg Pharmacy, Bldg 351, Laughlin Afb, TX 78843-5242 | 2006-02-02 |
| 1053399188 | 47th Medical Group | Clinic/Center | 590 Mitchell Blvd, Laughlin Afb, TX 78843-5242 | 2006-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427098011 | Maria Elisa Perez-johnson | Pediatrics | 315 Mitchell Blvd, 47th Mdg, Laughlin Afb, TX 78843 | 2006-06-08 |
| 1689144586 | Mi Casita Homecare, LLC. | Technician | 804 W. Edinburg Ave. Ste. D, Elsa, TX 78843-1614 | 2018-12-04 |
| 1184619520 | Patricia J Dalton | Nurse Practitioner | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2005-09-13 |
| 1356866107 | Elizabeth Heather Depalma | Nurse Practitioner | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2017-08-12 |
| 1760876791 | Susan J Ching | General Practice | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2015-03-27 |
| 1518374966 | 47 Mdss-laughlin Hospital | Military/U.S. Coast Guard Pharmacy | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2014-07-17 |
| 1396026597 | Stephen Ryan Emmerthal | Pharmacist | 590 Mitchell Blvd Bldg 375, Del Rio, TX 78843-5242 | 2011-08-31 |
| 1487932349 | Owen-john R. Williams | Psychologist | 590 Mitchell Blvd Bldg 375, 47th Mdg, Laughlin Afb, TX 78843-5242 | 2011-07-26 |
| 1386960946 | Felicia Ann Rinken | Optometrist | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2010-04-07 |
| 1790831816 | Micaela A Jett | Pediatrics | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2007-01-25 |
| Find all providers in zip 78843 | ||||
| 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 |
|---|---|---|---|---|
| 1518374966 | 47 Mdss-laughlin Hospital | Military/U.S. Coast Guard Pharmacy | 590 Mitchell Blvd Bldg 375, Laughlin Afb, TX 78843-5242 | 2014-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710532510 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 7800 W Ih 10 Ste 235, San Antonio, TX 78230-4768 | 2019-08-08 |
| 1508364258 | Wilford Hall Medical Center | Military/U.S. Coast Guard Pharmacy | 25615 Us Highway 281 N Ste 215, San Antonio, TX 78258-7135 | 2018-01-29 |
| 1831502590 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 2401 Scott Rd, Brooke Army Medical Center, Fort Sam Houston, TX 78234 | 2014-06-10 |
| 1124431317 | Carl R. Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | 4250 Clear Creek Rd, Room 406, Fort Hood, TX 76544-5095 | 2014-06-05 |
| 1134479413 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Torch St Rm C101, Bldg 21227, Ft Bliss, TX 79916 | 2012-09-14 |
| 1053618546 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 6501 Fm 3009, Suite 210, Schertz, TX 78154 | 2011-02-17 |
| 1740580125 | Carl R Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | 458 W Highway 190, Town Square Shopping Center, Copperas Cove, TX 76522-3904 | 2010-11-01 |
| 1477853851 | Carl R Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | Market Heights Shopping Center 201 E., Central Texas Expressway, Harker Heights, TX 76548 | 2010-11-01 |
| 1891003000 | Carl R Darnall Amry Medical Center | Military/U.S. Coast Guard Pharmacy | 2245 761st Tank Bn, Bldg 2245, Fort Hood, TX 76544 | 2010-09-22 |
| 1962718726 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Haan Rd, Ste A-11 Bldg 1611, Ft Bliss, TX 79916 | 2010-08-31 |
| Find all providers with the same taxonomy | ||||
| City | LAUGHLIN AFB |
| Zip Code | 78843 |
Please comment or provide details below to improve the information on 47TH MEDICAL GROUP SGSL.
| 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.