673RD MEDICAL GROUP JOINT BASE ELMENDORF-RICHARDSON (NPI# 1821402652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1821402652 |
Entity Type | Organization |
Organization Name | 673RD MEDICAL GROUP JOINT BASE ELMENDORF-RICHARDSON |
Other Organization Name | DOD FT RICHARDSON EPHCY |
Practice Address |
5955 Zeamer Ave 673rd Medical Group Jber AK 99506-3702 |
Mailing Address |
673rd Medical Group Joint Base Elmendorf-richardson Co 673d Medical Group Sgsr 5955 Zeamer Ave Jber AK 99506-3702 |
Practice Telephone | 9073840610 |
Practice Fax Number | 9073848195 |
Mailing Telephone | 9073840610 |
Mailing Fax Number | 9073848195 |
Enumeration Date | 2014-06-19 |
Last Update Date | 2014-06-27 |
Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
Authorized Official Telephone | 2102218443 |
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 | 2146326 | 01 |
Other Name | Type Code |
---|---|
DoD FT RICHARDSON ePhcy | Doing Business As Name - Organization |
Street Address |
5955 ZEAMER AVE 673RD MEDICAL GROUP |
City | JBER |
State | AK |
Zip Code | 99506-3702 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225031768 | Robert Fenton Tyree | Family Medicine | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2005-05-28 |
1457985210 | Allison Nicole Womble | Pharmacist | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2020-03-02 |
1982249579 | Nicolas Araiza Jr. | Social Worker | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2019-11-07 |
1235772732 | Sean Michael Batzer | Physical Therapist | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2019-10-28 |
1912540295 | Melody Megan Thompson | Nurse Practitioner | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2019-10-19 |
1932752771 | Kevin T Watanabe | Dietitian, Registered | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2019-07-22 |
1851853048 | Jordan Matthew Cate | Military Health Care Provider | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2019-04-05 |
1669933719 | Keith Happawana | Counselor | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2019-03-29 |
1104303320 | Luis Baltazar Baptista | Military Health Care Provider | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2018-07-20 |
1134611213 | Luke Acker | Psychologist | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2018-06-04 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1538797279 | Mark Pulver | Social Worker | 673mdg, Zeamer Avenue, Joint Base Elmendorf-richardson, AK 99506 | 2020-03-30 |
1871052837 | Ryan Kenny Zarnowski | Dentist | 673 Mdg, 5955 Zeamer Avenue, Jber, Ak 99506, Apo, AA 99506 | 2019-03-18 |
1679056659 | Bennett Robert Stadler | Physician Assistant | 673 Mdg 5955 Zeamer Avenue, Jber, AK 99506 | 2018-09-14 |
1437678687 | Mary Ann Barnard | Nurse Practitioner | Joint Base Elmendorf-richardson Hospital, 5955 Zeamer Ave, Anchorage, AK 99506 | 2017-09-19 |
1205375698 | Kuuipo Lau | Social Worker | 673d Mdg, 5955 Zeamer Ave., Jber, AK 99506 | 2017-02-17 |
1427434315 | Vance Knauer | Dentist | 673mdg 5955 Zeamer Ave, Jber, AK 99506 | 2015-08-03 |
1295112159 | Jacob Eby | Pediatrics | 673 Mdg 5955 Zeamer Ave, Jber, AK 99506 | 2015-04-29 |
1174956338 | Scott M Cheney | Physical Therapist | 673mdg, 5955 Zeamer Ave, Jber, AK 99506 | 2013-08-12 |
1518305580 | Jennifer Lynn Robison | Physician Assistant | 65955 Zeamer Avenue, Jber, AK 99506 | 2013-06-12 |
1588939664 | Paul Aaron Garrett | Emergency Medicine | 673rd Mdg, 5955 Zeamer Avenue, Jber, Apo, AA 99506 | 2012-03-21 |
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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 |
---|---|---|---|---|
1629481486 | 673rd Medical Group Joint Base Elmendorf-richardson Jber | Military/U.S. Coast Guard Pharmacy | 5800 Westover Ave, Jber, AK 99506-1603 | 2014-06-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427217447 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 131dg 661 Artic Ave, Fr Greely, AK 99731 | 2008-06-05 |
1104925262 | Us Coast Guard Finance Center | Military/U.S. Coast Guard Pharmacy | Bldg N46 Isc Kodiak, Kodiak, AK 99619 | 2006-09-22 |
1306945464 | 354th Medical Group Mdg | Military/U.S. Coast Guard Pharmacy | Bldg 3349 Central Ave, Eielson Afb, AK 99702 | 2006-09-22 |
1013016179 | Us Coast Guard Finance Center | Military/U.S. Coast Guard Pharmacy | 1300 Stedman Stisc Ketchikan, Ketchikan, AK 99901 | 2006-09-22 |
1053418806 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1060 Gaffney Rd Stop 7420, Bldg 4065, Ft Wainwright, AK 99703-5007 | 2006-09-20 |
1295149383 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bassett Army Community Hospital, Meddac-alaska 1060 Gaffney Rd #7400, Ft. Wainwright, AK 99703-7400 | 2014-06-17 |
1902218415 | 354 Mdg | Military/U.S. Coast Guard Pharmacy | 2630 Central Ave Ste 1m07, Eielson Afb, AK 99702-2325 | 2014-06-02 |
1285948877 | Hswl Fo Kodiak Det Ketchikan | Military/U.S. Coast Guard Pharmacy | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2010-08-06 |
1053410100 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1060 Gaffney Rd Stop 7400, Building 3406, Ft Wainwright, AK 99703-5007 | 2006-09-22 |
1497854558 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1060 Gaffney Rd Stop 7400, Bldg 4065, Ft Wainwright, AK 99703-5007 | 2006-09-22 |
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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.