377TH MEDICAL GROUP (NPI# 1740694553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740694553 |
| Entity Type | Organization |
| Organization Name | 377TH MEDICAL GROUP |
| Other Organization Name | DOD KIRTLAND EPHCY |
| Practice Address |
1501 San Pedro Dr Se Bldg 47 Albuquerque NM 87108-5153 |
| Mailing Address |
377 Th Medical Group 2050a Second St. Se Kirtland Afb NM 87117-0001 |
| Practice Telephone | 5058467775 |
| Practice Fax Number | 5058463137 |
| Mailing Telephone | 5058467775 |
| Mailing Fax Number | 5058463137 |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2015-06-22 |
| 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 | 2146419 | 01 |
| Other Name | Type Code |
|---|---|
| DoD KIRTLAND ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962501312 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | Gibson Blvd Bldg 20167, Albuquerque, NM 87108 | 2006-09-22 |
| 1912982810 | 377th Medical Group | Clinic/Center | 2050a Second St Se, Kirtland Afb, NM 87117-5524 | 2005-12-13 |
| 1073610820 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 2050a 2nd St Se, Kirtland Afb, NM 87117-5524 | 2006-09-20 |
| Street Address |
1501 SAN PEDRO DR SE BLDG 47 |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87108-5153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295723112 | Ronald J Morrell | Family Medicine | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2005-10-13 |
| 1154834323 | Katherine Marie Churchwell | Nurse Practitioner | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2017-11-09 |
| 1295155398 | Lindsey Cline | Pediatrics | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2014-04-16 |
| 1235367574 | Ryan Dorsey-spitz | Family Medicine | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2009-06-25 |
| 1538235916 | Darlene Stilling | Nurse Practitioner | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2006-11-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274393 | Aubrey Bunnenberg | Behavior Technician | 114 Pennsyvlania St. Ne Apt. 1, Albuquerque, NM 87108 | 2020-08-06 |
| 1336757301 | Dailey Doss | Physician Assistant | Raymond G. Murphy Va Medical Center, 1501 San Pedro Se, Albuquerque, NM 87108 | 2020-07-16 |
| 1457990046 | Christine Lovato | Registered Nurse | Albuquerque Treatment Services LLC, 123 Madeira Dr Se, Albuquerque, NM 87108 | 2019-12-30 |
| 1265074405 | Andrew Jacob Reuter | Pharmacist | 3816 Copper Ave Ne, Unit A, Albuquerque, NM 87108 | 2019-10-09 |
| 1518517325 | Lillian Abeyta | Technician | 1501 San Pedro Dr Se., Albuquerque, NM 87108 | 2019-09-13 |
| 1962970061 | Donald Borrego | Occupational Therapy Assistant | 5200 Copper Ne, #7, Albuquerque, NM 87108 | 2018-11-06 |
| 1154808012 | Catalina Castro | Social Worker | 209 San Pablo Se, Albuquerque, NM 87108 | 2018-07-24 |
| 1942721048 | Walgreen Co | Pharmacy | 933 San Mateo Blvd Ne Ste 501, Albuquerque, NM 87108 | 2017-06-29 |
| 1467981860 | Jennifer Martinez | Behavior Technician | 628 Espanola Se, Albuquerque, NM 87108 | 2017-06-08 |
| 1457892465 | J Dowd Counseling LLC | Counselor | 514 Monroe Street Se, Albuquerque, NM 87108 | 2017-03-10 |
| Find all providers in zip 87108 | ||||
| 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 |
|---|---|---|---|---|
| 1962501312 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | Gibson Blvd Bldg 20167, Albuquerque, NM 87108 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952716896 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | 1363 Aberdeen Road, White Sands Missile Range, NM 88002-5520 | 2014-06-30 |
| 1316253297 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Hawk Rd, Rm 9503-11, Chaparrel, NM 88021 | 2010-08-30 |
| 1780783134 | William Beaumont Army Medical | Military/U.S. Coast Guard Pharmacy | Aberdeen Ave, Bldg 1363, White Sand Missile Range, NM 88002 | 2006-09-22 |
| 1871692228 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103-5009 | 2006-09-22 |
| 1417356072 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W D L Ingram Blvd, Cannon Afb, NM 88103-5103 | 2014-08-20 |
| 1356755185 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St Bldg 15, Holloman Afb, NM 88330-8273 | 2014-06-19 |
| 1023172772 | Cannon Refill Phcy | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103 | 2006-12-20 |
| 1073610820 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 2050a 2nd St Se, Kirtland Afb, NM 87117-5524 | 2006-09-20 |
| 1982701736 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Holloman Afb, NM 88330-8273 | 2006-09-20 |
| 1952374910 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Sgsr, Holloman Afb, NM 88330-8273 | 2006-02-09 |
| Find all providers with the same taxonomy | ||||
| City | ALBUQUERQUE |
| Zip Code | 87108 |
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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.