22ND MEDICAL GROUP (NPI# 1952716847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952716847 |
| Entity Type | Organization |
| Organization Name | 22ND MEDICAL GROUP |
| Other Organization Name | DOD MCCONNELL EPHCY |
| Practice Address |
57950 Leavenworth St Ste 4e1 Mcconnell Afb KS 67221-3506 |
| Mailing Address |
22nd Medical Group 57950 Leavenworth St. 6e4 Mcconnell Afb KS 67221-3506 |
| Practice Telephone | 3167595277 |
| Practice Fax Number | 3167596776 |
| Mailing Telephone | 3167595277 |
| Mailing Fax Number | 3167596776 |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2016-01-08 |
| 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 |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2146568 | 01 |
| Other Name | Type Code |
|---|---|
| DoD MCCONNELL ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467514489 | 22nd Medical Group | Pharmacy | 57590 Leavenworth Bldg 250, Mcconnell Afb, KS 67221 | 2006-12-15 |
| 1962564948 | 22nd Medical Group | Pharmacy | Bldg 250 57590 Leavenworth Ave, Mcconnell Afb, KS 67221-3506 | 2006-12-15 |
| 1033445085 | 22nd Medical Group | Pharmacy | 57950 Leavenworth St, Building 250, Mcconnell Afb, KS 67221-3506 | 2009-10-27 |
| 1154420784 | 22nd Medical Group | Pharmacy | 57950 Leavenworth St, St 6 E 4, Mcconnell Afb, KS 67221-3506 | 2006-09-21 |
| Street Address |
57950 LEAVENWORTH ST STE 4E1 |
| City | MCCONNELL AFB |
| State | KS |
| Zip Code | 67221-3506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659581197 | Jeffrey Scott Hayes | Licensed Practical Nurse | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221-3506 | 2007-05-23 |
| 1508327818 | Chang Inn Kim | Pharmacist | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221-3506 | 2019-03-28 |
| 1407296940 | Daniel Richard Galle | Optometrist | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221-3505 | 2013-06-28 |
| 1962707067 | Melissa M Wendt | Physician Assistant | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221 | 2011-01-20 |
| 1073760542 | Matthew Scott Davis | Physician Assistant | 57950 Leavenworth St Ste 4e1, Mcconnell Afb, KS 67221-3506 | 2008-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922528421 | Rose Lee Samples | Nurse Practitioner | 51950 Leavenworth St., Family Health Clinic 22 Mdg, Mcconnell Afb, KS 67221 | 2017-06-26 |
| 1114247913 | Dawn Marie Clifton | Nurse Practitioner | 57950 Leavenworth Ave Bldg 250, 22d Medical Group, Mcconnell Afb, KS 67221 | 2010-06-03 |
| 1467514489 | 22nd Medical Group | Pharmacy | 57590 Leavenworth Bldg 250, Mcconnell Afb, KS 67221 | 2006-12-15 |
| 1336182153 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | Derby Street, Building 352, Mcconnell Afb, KS 67221 | 2006-06-13 |
| 1578919049 | Kathryn Rachel Kocher | Pediatrics | 57950 Leavenworth St, Mcconnell Afb, KS 67221 | 2016-05-13 |
| 1922232271 | Richard Jimenez Rubi | Military Health Care Provider | 22 Mdg, Mcconnell Afb, KS 67221 | 2009-05-14 |
| 1871581306 | Joshua A Hartman | Emergency Medicine | 57950 Leavenworth St Bldg 248, Mcconnell Afb, KS 67221-3505 | 2005-10-10 |
| 1184242604 | Lindsey Allison Cunningham | Dentist | 57950 Leavenworth St, Wichita, KS 67221-3505 | 2020-07-10 |
| 1164052700 | Taylor Holloway | Family Medicine | 57950 Leavenworth St Bldg 250, Mcconnell Afb, KS 67221-3505 | 2020-01-23 |
| 1669969424 | Alesha Avis Heinz | Student in an Organized Health Care Education/Training Program | 57950 Leavenworth Street, Suite 4e1, Mcconnell Afb, KS 67221-3506 | 2018-04-17 |
| Find all providers in zip 67221 | ||||
| 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 |
|---|---|---|---|---|
| 1639403090 | 22nd Medgp/sgsla | Military/U.S. Coast Guard Pharmacy | 57950 Leavenworth St, Mcconnell Afb, KS 67221-3506 | 2009-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932421658 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 2210 Trooper Drive, Ft Riley, KS 66442 | 2010-02-22 |
| 1023330743 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 8072 Normandy Drive, Ft Riley, KS 66442 | 2010-02-22 |
| 1841352580 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Building 600, Ft Riley, KS 66442 | 2006-12-15 |
| 1316046949 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 600, Caisson Hill Road, Ft Riley, KS 66442 | 2006-09-21 |
| 1265814842 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 623 Southwind Drive, Junction City, KS 66441 | 2015-06-19 |
| 1740696095 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 600 Caisson Hill Rd, Fort Riley, KS 66442-7037 | 2014-07-08 |
| 1730593567 | Munson Army Health Center | Military/U.S. Coast Guard Pharmacy | 550 Pope Ave, Munson Army Health Center, Fort Leavenworth, KS 66027-2332 | 2014-06-19 |
| 1679637334 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Building 600, Ft Riley, KS 66442 | 2006-12-20 |
| 1245339878 | Irwin Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 650 Huebner Rd, Ft Riley, KS 66442 | 2006-09-21 |
| 1457458200 | Munson Army Health Center | Military/U.S. Coast Guard Pharmacy | 550 Pope Ave, Fort Leavenworth, KS 66027-2332 | 2006-09-20 |
| Find all providers with the same taxonomy | ||||
| City | MCCONNELL AFB |
| Zip Code | 67221 |
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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.