DAVID S GRANT MEDICAL CENTER


Address: 461 Skymaster Cir Rm 149, Travis Afb, CA 94535-1909
Phone: 7074235345

DAVID S GRANT MEDICAL CENTER (NPI# 1043622681) 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) 1043622681
Entity Type Organization
Organization Name DAVID S GRANT MEDICAL CENTER
Other Organization Name DOD TRAVIS EPHCY
Practice Address 461 Skymaster Cir Rm 149
Travis Afb
CA 94535-1909
Mailing Address David S Grant Medical Center Co 60th Mdg
101 Bodin Cir
Travis Afb
CA 94535-1809
Practice Telephone 7074235345
Practice Fax Number 7074235346
Mailing Telephone 7074237657
Mailing Fax Number 7074237994
Enumeration Date 2014-06-02
Last Update Date 2016-01-21
Authorized Official Name HECTOR MORALES (CHIEF DHA PASS)
Authorized Official Telephone 2105366650
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 2146026 01

Other Provider/Organization Names

Other Name Type Code
DoD TRAVIS ePhcy Doing Business As Name - Organization

Office Location

Street Address 461 SKYMASTER CIR RM 149
City TRAVIS AFB
State CA
Zip Code 94535-1909

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1508487711 Sheila C Flood Student in an Organized Health Care Education/Training Program 101 Biden Circle, Fairfield, CA 94535 2020-04-28
1568081255 Miguel Julian Moreno Student in an Organized Health Care Education/Training Program 690 Airmen Drive, Travis Afb, CA 94535 2020-04-13
1174096101 Zlatoslava Karga Nurse Practitioner 60mdg / Sgow, 101 Bodin Circle, Travis Afb, CA 94535 2019-01-02
1437648292 Luke C Vera Dentist David Grant Medical Center 101 Bodin Circle, Travis Air Force Base, CA 94535 2018-05-08
1588163430 Sanaz Ziad Pharmacist 60mdg/mdts, 101 Bodin Circle, Travis Afb, CA 94535 2018-02-06
1194265686 Geoffrey Johnston Dentist 60 Mdg/sgdd, 101 Bodin Circle, Travis Afb, CA 94535 2017-03-02
1336693407 Hannah Isla Nordwall Social Worker 60 Mdg/mdos 101 Bodin Cir, Travis Afb, CA 94535 2016-08-06
1184177149 Taylor Murrie-robinson Social Worker 60mdg / Sgow Mental Health Clinic, 101 Bodin Circle, Travis Afb, CA 94535 2016-07-26
1952759607 Eric Kincaid-sharp General Practice 60 Mdg/amds, 101 Bodin Cir, Travis Afb, CA 94535 2016-06-02
1023472040 Genieve Marie Martinez-hernandez Internal Medicine 60 Mdg/sgomi, 101 Bodin Circle, Fairfield, CA 94535 2016-04-06
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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
1528167582 60th Medical Group Sgsl Military/U.S. Coast Guard Pharmacy 101 Bodin Cir Rm 1c409, Travis Afb, CA 94535-1809 2006-09-22
1942309919 60th Medical Group Sgsl Military/U.S. Coast Guard Pharmacy Skymaster Blvd Bldg 650 Rm 149, Travis Afb, CA 94535-1800 2006-09-22
1346349305 60th Medical Group Sgsl Military/U.S. Coast Guard Pharmacy 101 Bodin Cir Rm 1c409, Travis Afb, CA 94535-1809 2006-09-22
1265531222 60th Medical Group Sgsl Military/U.S. Coast Guard Pharmacy Skymaster Blvd Bldg 650 Rm 149, Travis Afb, CA 94535-1800 2006-09-22
1205896701 David Grant Medical Center Military/U.S. Coast Guard Pharmacy 101 Bodin Cir, 60th Medical Group, Travis Afb, CA 94535-1809 2006-03-27

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1952765125 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy 135 Santa Margarita Rd, Camp Pendelton, CA 92055 2016-04-13
1821485152 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy Hospital Camp Pendelton, 200 Mercy Circle, Camp Pendelton, CA 92055 2015-04-24
1275948143 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy Basilone Road, Bldg 520450, Camp Pendleton, CA 92055 2014-06-30
1265846323 Naval Medical Center San Diego Military/U.S. Coast Guard Pharmacy 34800 Bob Wilson Dr Ste 3, San Diego, CA 92134-1003 2014-06-17
1285048348 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy 41 Area Las Flores Nelson, Bldg 414006, Camp Pendleton, CA 92055 2014-06-17
1205249042 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy 13 Area Branch Medic, Bldg 13129 14th St, Camp Pendelton, CA 92055 2014-06-10
1275946444 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy Hq Regiment, 16th Street, Camp Pendelton, CA 92055 2014-06-05
1366855538 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy Hq Reg 1 Mlg Ras, Bldg 14008, Camp Pendelton, CA 95008 2014-06-05
1841603248 Naval Hospital Camp Pendleton Military/U.S. Coast Guard Pharmacy Branch Medical Clinic Naf, Bldg 23, El Centro, CA 92055 2014-06-04
1154733947 Naval Hospital Twentynine Palms Military/U.S. Coast Guard Pharmacy 1151 Sturgis Street, Twentynine Palms, CA 92278-8250 2014-05-28
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Competitor

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City TRAVIS AFB
Zip Code 94535

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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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