71TH MEDICAL GROUP SGSL (NPI# 1710086079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1710086079 |
Entity Type | Organization |
Organization Name | 71TH MEDICAL GROUP SGSL |
Other Organization Name | VANCE PHCY 71ST MDG |
Practice Address |
527 Gott Rd Enid OK 73705-5103 |
Practice Telephone | 5802137783 |
Practice Fax Number | 5802137995 |
Mailing Telephone | 5802137783 |
Mailing Fax Number | 5802137995 |
Enumeration Date | 2006-09-22 |
Last Update Date | 2016-01-22 |
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 | 2076297 | 01 |
Other Name | Type Code |
---|---|
VANCE PHCY 71ST MDG | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508965831 | 71th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 4881 Sugar Maple Dr, Bldg 1250, Wright Patter, OH 45433-5529 | 2006-09-22 |
Street Address |
527 GOTT RD |
City | ENID |
State | OK |
Zip Code | 73705-5103 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043200793 | David Barnard | Family Medicine | 527 Gott Rd, Enid, OK 73705-5103 | 2005-10-25 |
1184225138 | Danielle Young | Social Worker | 527 Gott Rd, Enid, OK 73705-5103 | 2020-11-05 |
1598301277 | Anh N Ison | Pharmacist | 527 Gott Rd, Enid, OK 73705-5103 | 2019-11-18 |
1336792340 | Liam Connall Noone | Military Health Care Provider | 527 Gott Rd, Enid, OK 73705-5103 | 2019-07-18 |
1225598980 | Andrew Jonathan Carey | Military Health Care Provider | 527 Gott Rd, Enid, OK 73705-5103 | 2019-03-20 |
1801306188 | Scott Lynn Chance | Pharmacist | 527 Gott Rd, Enid, OK 73705-5103 | 2017-10-02 |
1114458957 | Chang Liu Lipinski | Family Medicine | 527 Gott Rd, Enid, OK 73705-5103 | 2017-03-23 |
1417349697 | Usaf | Military Hospital | 527 Gott Rd, Enid, OK 73705-5103 | 2015-02-25 |
1962818336 | 71 Mdg Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 527 Gott Rd, Enid, OK 73705-5103 | 2014-07-07 |
1689080418 | Alison Allen | Pediatrics | 527 Gott Rd, Enid, OK 73705-5103 | 2014-07-01 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699074013 | Christopher Lee Endres | Military Health Care Provider | 527 Gott Road, Vance Clinic, Vance Afb, OK 73705 | 2011-03-24 |
1578128070 | Jason Ruggieri | Psychologist | 527 Gott Road, Bldg 816, Enid, OK 73705-5103 | 2019-05-09 |
1831556455 | Jennifer Anne Barclay | Pediatrics | 527 Gott Rd Bldg 810, Enid, OK 73705-5103 | 2016-01-27 |
1669991758 | Omer S Sanabria | Dentist | 71st Mdg, 527 Gott Rd., Bldg 810, Enid, OK 73705-5105 | 2017-09-11 |
1164661096 | Traci Lynn Johnson | Licensed Vocational Nurse | 71 Mdg, 527 Gott Rd, Vance Afb, OK 73705-5105 | 2009-02-17 |
1255395174 | Christopher Makoto Tsueda | Family Medicine | 71 Medical Group, 527 Gott Road, Vance Afb, OK 73705-5105 | 2006-04-17 |
1447393889 | William F. Blackerby | Clinical Neuropsychologist | 71 Medical Group, 527 Gott Road Vance Afb, Enid, OK 73705-5105 | 2007-02-15 |
1306820915 | Ronald Stuart Johnson | Psychologist | 320 Young Rd, 71 Mdos/sgoml Building 248, Enid, OK 73705-5506 | 2005-12-06 |
1851659809 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 242 Fields St Bldg 415, Enid, OK 73705-5700 | 2012-04-27 |
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 |
---|---|---|---|---|
1962818336 | 71 Mdg Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 527 Gott Rd, Enid, OK 73705-5103 | 2014-07-07 |
1932187838 | 71st Medical Group | Military/U.S. Coast Guard Pharmacy | 527 Gott Rd, Enid, OK 73705-5103 | 2006-01-03 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457654766 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Custer Road, Bldg 2913, Fort Sill, OK 73503 | 2010-12-08 |
1831298017 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Macomb Rd Bldg 1719, Ft Sill, OK 73503 | 2006-09-22 |
1740389923 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Thomas Rd Bldg 6043 Tmc2, Ft Sill, OK 73503 | 2006-09-22 |
1194824458 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Reynolds Comm Hosp Dept of Phcy, 4300 Thomas St Bldg 4300, Ft Sill, OK 73503 | 2006-09-22 |
1982703245 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Us Army Health Clinic Aar Mcalester, Ic Tree Road, Mcalester, OK 74301-5000 | 2006-09-22 |
1245337096 | 72 Nd Medical Group | Military/U.S. Coast Guard Pharmacy | 5700 Arnold St Bldg 5801, Tinker Afb, OK 73145-8105 | 2006-09-20 |
1801871371 | 72d Medical Group | Military/U.S. Coast Guard Pharmacy | 5700 Arnold St., Tinker Afb, OK 73145-8012 | 2005-12-07 |
1568877702 | Department of The Air Force 72d Medical Group | Military/U.S. Coast Guard Pharmacy | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2014-06-26 |
1225442056 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 4301 Wilson St, Reynolds Army Community Hospital, Fort Sill, OK 73503-4472 | 2014-06-19 |
1912200221 | Renolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 5404 Sw Lee Blvd, Lawton, OK 73505-9695 | 2010-12-08 |
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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.