673RD MEDICAL GROUP JOINT BASE ELMENDORF-RICHARDSON


Address: 5955 Zeamer Ave, 673rd Medical Group, Jber, AK 99506-3702
Phone: 9073840610

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 332000000X Military/U.S. Coast Guard Pharmacy Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
PK 2146326 01

Other Provider/Organization Names

Other Name Type Code
DoD FT RICHARDSON ePhcy Doing Business As Name - Organization

Office Location

Street Address 5955 ZEAMER AVE
673RD MEDICAL GROUP
City JBER
State AK
Zip Code 99506-3702

Providers in the same location

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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Providers in the same zip code

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 Information

Taxonomy Code 332000000X
Grouping Suppliers
Classification Military/U.S. Coast Guard Pharmacy

Taxonomy Definition

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]

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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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City JBER
Zip Code 99506

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Dataset Information

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.

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