20TH MEDICAL SUPPORT SQUADRON (NPI# 1881009033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881009033 |
| Entity Type | Organization |
| Organization Name | 20TH MEDICAL SUPPORT SQUADRON |
| Other Organization Name | DOD SHAW EPHCY |
| Practice Address |
431 Meadowlark St Shaw Afb SC 29152-5019 |
| Mailing Address |
20th Medical Support Squadron Us Air Force Hospital 431 Meadowlark St Shaw Afb SC 29152 |
| Practice Telephone | 8038951309 |
| Practice Fax Number | 8038956463 |
| Mailing Telephone | 8038951309 |
| Mailing Fax Number | 8038956463 |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2016-01-19 |
| 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 | 2146551 | 01 |
| Other Name | Type Code |
|---|---|
| DoD SHAW ePhcy | Doing Business As Name - Organization |
| Street Address |
431 MEADOWLARK ST |
| City | SHAW AFB |
| State | SC |
| Zip Code | 29152-5019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427667765 | Jaclyn C Hoffman | Registered Nurse | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2020-07-22 |
| 1285068296 | Sidonia Lee Alo | Military Health Care Provider | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2013-08-27 |
| 1083966824 | Ryan R Landoll | Student in an Organized Health Care Education/Training Program | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2012-10-03 |
| 1720337462 | Scott B Wyatt | Military Health Care Provider | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2012-09-07 |
| 1699809475 | Jodi Ann Memery | Social Worker | 431 Meadowlark St, 20th Medical Group Mental Health Clinic, Shaw Afb, SC 29152-5019 | 2007-03-15 |
| 1881786879 | Daniel Anthony Blaz | Nurse Practitioner | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-09-28 |
| 1851490031 | 20th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-09-22 |
| 1336112440 | 20th Medical Group Shaw | Military/U.S. Coast Guard Pharmacy | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487201695 | Ethan Lee Brockett | Dentist | Shaw Afb Dental Clinic, Shaw Afb, AE 29152 | 2019-08-22 |
| 1275066821 | Travis B Grindstaff | General Acute Care Hospital | 411 Polifka Dr, Shaw Afb, SC 29152 | 2017-04-10 |
| 1851791578 | Terrance Walker | Psychologist | 431 Meadow St, Sumter, SC 29152 | 2014-08-29 |
| 1124258967 | Jacqueline Mintz | Nurse Practitioner | 524 Nelson Ave, Shaw Afb, SC 29152 | 2009-07-14 |
| 1396970117 | Jennifer N Steele | Military Health Care Provider | 411 Meadowlark St, Shaw A F B, SC 29152 | 2009-05-22 |
| 1285899146 | Elizabeth Ann Vandevelde | Nurse Practitioner | 129 North Washington, Tuomey Healthcare System, Sumter, SC 29152 | 2008-07-21 |
| 1134211089 | Kibrom T Mehari | Dentist | 449 Shaw Dr, Shaw A F B, SC 29152 | 2006-09-29 |
| 1134155773 | Theresa Jean Ulichney | Registered Nurse | 420 Polifka Dr, Shaw Afb, SC 29152 | 2006-06-24 |
| 1366415184 | Kimberly Marie Shanks | Nurse Practitioner | 431 Meadowlark Rd, Shaw Afb, SC 29152 | 2006-02-10 |
| 1194710780 | Anthony Shawn Bankes | Family Medicine | 411 Medowlark, Shaw Afb, SC 29152 | 2005-09-20 |
| Find all providers in zip 29152 | ||||
| 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 |
|---|---|---|---|---|
| 1760581946 | 20th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 515 Exchange St, Bldg 1448, Shaw Afb, SC 29152-5033 | 2006-09-22 |
| 1851490031 | 20th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-09-22 |
| 1336112440 | 20th Medical Group Shaw | Military/U.S. Coast Guard Pharmacy | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669877064 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1021 Pinnacle Point Dr Ste 200, Columbia, SC 29223-5740 | 2014-10-28 |
| 1114332368 | 628 Medical Group | Military/U.S. Coast Guard Pharmacy | 204 W Hill Blvd Bldg 364, Charleston Afb, SC 29404-4704 | 2014-06-26 |
| 1306945563 | Naval Hospital Beaufort | Military/U.S. Coast Guard Pharmacy | Bldg 669, Parris Island, SC 29905 | 2006-09-22 |
| 1235238411 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4500, Stuart Street, Ft Jackson, SC 29207 | 2006-09-22 |
| 1043319213 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4575, Marion Ave, Ft Jackson, SC 29207 | 2006-09-22 |
| 1881793057 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 4716, Commissary Rd, Ft Jackson, SC 29207 | 2006-09-22 |
| 1811309339 | Naval Hospital Beaufort | Military/U.S. Coast Guard Pharmacy | 1 Pinckney Blvd, Naval Hospital Beaufort, Beaufort, SC 29902 | 2014-06-02 |
| 1073802807 | Moncrief Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 4500 Stuart Ave, Columbia, SC 29207-5700 | 2011-04-01 |
| 1972602134 | 628 Medical Group | Military/U.S. Coast Guard Pharmacy | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2006-09-22 |
| 1881793040 | Naval Hospital Beaufort | Military/U.S. Coast Guard Pharmacy | 1 Pinckney Blvd, Bldg 1, Beaufort, SC 29902 | 2006-09-22 |
| Find all providers with the same taxonomy | ||||
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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.