KEESLER MEDICAL CENTER 81MDSS SGSR (NPI# 1710967526) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710967526 |
| Entity Type | Organization |
| Organization Name | KEESLER MEDICAL CENTER 81MDSS SGSR |
| Practice Address |
301 Fisher St Ste 101 Rm 1a132 Keesler Afb MS 39534-2508 |
| Practice Telephone | 2283774526 |
| Practice Fax Number | 2283774559 |
| Mailing Telephone | 2283774526 |
| Mailing Fax Number | 2283774559 |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2010-11-15 |
| Authorized Official Name | SERENA LYNN HANSKEN (AIR FORCE UNIFORM BUSINESS OFFICE) |
| Authorized Official Telephone | 7035886419 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| N | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities | ||
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| Y | 286500000X | Military Hospital | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | NCPDP | 2518338 | 01 |
| Street Address |
301 FISHER ST STE 101 RM 1A132 |
| City | KEESLER AFB |
| State | MS |
| Zip Code | 39534-2508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215929039 | Roger E Pradelli | Dentist | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2005-08-17 |
| 1508427394 | Anthony Wayne Reddin Jr. | Nurse Anesthetist, Certified Registered | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2019-06-24 |
| 1215496575 | Benjamin Douglas | Physician Assistant | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2019-03-17 |
| 1801381736 | Francis Essien | Student in an Organized Health Care Education/Training Program | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2018-06-23 |
| 1932697893 | Eric James Rigg | Student in an Organized Health Care Education/Training Program | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2018-04-26 |
| 1912401084 | Shannon Reed | Advanced Practice Midwife | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2018-03-22 |
| 1568972586 | Nicholas P Robertson | Registered Nurse | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2017-10-04 |
| 1578093126 | Jaclyn Kaye Stacy | Internal Medicine | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2017-06-15 |
| 1700315686 | Joseph Cook | Internal Medicine | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2017-06-05 |
| 1861926461 | Benjamin Robert Prince | Family Medicine | 301 Fisher St, Keesler Afb, MS 39534-2508 | 2017-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316568918 | Hanna Chang | Student in an Organized Health Care Education/Training Program | 81 Msgs/gme (keesler Afb), 301 Fisher St, Rm 5a127, Biloxi, MS 39534 | 2020-05-05 |
| 1720617079 | Briana Polk | Student in an Organized Health Care Education/Training Program | Keesler Air Force Base, 301 Fisher Street, Biloxi, MS 39534 | 2020-04-07 |
| 1437718756 | Marquise Westbrook | Student in an Organized Health Care Education/Training Program | 301 Fisher St, Rm 1g123, Keesler Afb, MS 39534 | 2019-06-11 |
| 1124682729 | Joseph Paul Cervone | Student in an Organized Health Care Education/Training Program | 81 Mdss/gme 301 Fisher St, Rm 1g123, Keesler Afb, MS 39534 | 2019-04-29 |
| 1083120851 | Kaitlin May Gruenberg | Student in an Organized Health Care Education/Training Program | 81 Msgs/gme, 301 Fisher St, Rm 5a127, Keesler Afb, MS 39534 | 2017-12-15 |
| 1760912513 | Michael Zipper | Military Health Care Provider | 301 Fisher St, Rm 5a127, 81msgs/sgcq, Keesler Afb, MS 39534 | 2017-06-14 |
| 1184073181 | 81msgs/sgcq | General Acute Care Hospital | 81msgs/sgcq, 301 Fisher St, Rm 5a127, Keesler Afb, MS 39534 | 2016-06-09 |
| 1174972772 | Usaf 81st Medical Group | Military Hospital | 81msgs/sgcq 301 Fisher St, Rm 5a127, Keesler Afb, MS 39534 | 2016-06-06 |
| 1548644677 | Jim Li | Dentist | 81st Medical Group, Keesler Afb, Apo, AA 39534 | 2015-07-18 |
| 1245610872 | Zachary Austin Masters | Surgery | 301 Fisher Street, Rm 5a127, Keesler Air Force Base, MS 39534 | 2015-06-09 |
| Find all providers in zip 39534 | ||||
| Taxonomy Code | 286500000X |
| Grouping | Hospitals |
| Classification | Military Hospital |
| A health care facility operated by the Department of Defense. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174972772 | Usaf 81st Medical Group | Military Hospital | 81msgs/sgcq 301 Fisher St, Rm 5a127, Keesler Afb, MS 39534 | 2016-06-06 |
| 1023302957 | 81st Medical Group | Military Hospital | 301 Fisher St, 81 Mdos Sgof, Keesler Afb, MS 39534-2508 | 2011-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609268267 | Veterans Health Adminstration | Military Hospital | 947 Clubhouse Dr, Pearl, MS 39208-9528 | 2015-02-19 |
| 1407290703 | G.v. Sonny Montgomery Medical Center | Military Hospital | 425 Beasley Rd Apt K5, Jackson, MS 39206-2929 | 2013-04-18 |
| 1932360815 | Samuel Leroy Graham | Military Hospital | 14115 Fred and Al Key Rd, Kiln, MS 39556-8060 | 2008-06-23 |
| 1497930184 | Department of Veterans Affair G.v. (sonny) Montgomery Va Medical Cente | Military Hospital | 5942 Westmore Dr, Jackson, MS 39206-2209 | 2008-01-01 |
| 1831495415 | U.S. Department of Veterans Affairs | Military Hospital | 400 Veterans Ave, T100 (social Work), Biloxi, MS 39531-2410 | 2011-01-31 |
| 1265508287 | Va Jackson | Military Hospital | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2006-11-28 |
| 1023043619 | Keesler Medical Center | Military Hospital | 301 Fisher St, Biloxi, MS 39534-2508 | 2006-07-11 |
| City | KEESLER AFB |
| Zip Code | 39534 |
Please comment or provide details below to improve the information on KEESLER MEDICAL CENTER 81MDSS SGSR.
| 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.