NAVAL HEALTH CLINIC NEW ENGLAND (NPI# 1073603304) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073603304 |
| Entity Type | Organization |
| Organization Name | NAVAL HEALTH CLINIC NEW ENGLAND |
| Practice Address |
1 Wahoo Ave Building 449 Groton CT 06349-2324 |
| Mailing Address |
Naval Branch Health Clinic Groton 1 Wahoo Ave Groton CT 06349 |
| Practice Telephone | 8886289633 |
| Practice Fax Number | 8606942367 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2017-10-25 |
| Authorized Official Name | WILLIAM M CONDON (BUMED UBO) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL HEALTH CLINIC NEW ENGLAND |
| 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 | 2002351 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083713242 | Naval Health Clinic New England | Pharmacy | Bldg 291 King Hall, Naval Ambulatory Care Ctr, King Hall, RI 02841 | 2006-09-22 |
| 1154420438 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | Navy Branch Medical Clinic, One West Ave Suite 230, Saratoga Springs, NY 12866 | 2006-09-22 |
| 1881791630 | Naval Health Clinic New England | Pharmacy | Nhcne, Pharmacy 43 Smith Rd Bld 43, Newport, RI 02841 | 2006-09-20 |
| 1437256286 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | 1 Ayers Circle Bldg H1, Portsmouth, NH 03801 | 2006-09-20 |
| 1629515911 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | 1 Ayers Circle, Bldg H-1, Kittery, ME 03904 | 2017-01-24 |
| 1437564671 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | 1 West Ave Ste 230, Saratoga Springs, NY 12866-6050 | 2014-06-26 |
| 1124431978 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | One Ayres Circle, Bldg H-1, Kittery, ME 03904 | 2014-06-10 |
| 1588077713 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | 1 Riggs Rd, Newport, RI 02841-1000 | 2014-06-05 |
| 1639581143 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | 1 Wahoo Ave Bldg 449, Groton, CT 06349-2324 | 2014-06-02 |
| 1538128350 | Naval Health Clinic New England | Clinic/Center | 43 Smith Rd, Building 43, Room 1063, Newport, RI 02841-1002 | 2006-03-21 |
| Street Address |
1 WAHOO AVE BUILDING 449 |
| City | GROTON |
| State | CT |
| Zip Code | 06349-2324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043207004 | Matthew Braden Burns Miller | Dentist | 1 Wahoo Ave, Groton, CT 06349 | 2005-10-04 |
| 1063027407 | Jimmy Nazih Suliman | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-09-12 |
| 1790395242 | Duc-nhan Nguyen Pham | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-08-08 |
| 1770112708 | Amanda Kathleen Dobyns | Occupational Therapist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-04-02 |
| 1831732825 | Cody Clark | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-10-22 |
| 1477103059 | Jordan Taylor Rucinski | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-09-16 |
| 1699335372 | Cynthia Daigneault | Counselor | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-06-16 |
| 1942868211 | Cameron Anson Martin | Military Health Care Provider | 1 Wahoo Ave, Groton, CT 06340 | 2019-06-03 |
| 1104386903 | Zena Sabath | General Practice | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-03-20 |
| 1538636527 | Winston Eugene Young | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2018-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205434347 | Mvca | Optometrist | Navy Submarine Base New London, Bldg 484, Groton, CT 06349 | 2020-10-12 |
| 1376194274 | Christopher Lee Roy Smith | Military Health Care Provider | Uss San Juan (ssn 751), Groton, CT 06349 | 2019-09-23 |
| 1588127575 | Morgan Ross Jones | Student in an Organized Health Care Education/Training Program | Bx 159 Navsubase Nlon, Groton, CT 06349 | 2019-04-08 |
| 1689179640 | David Saunders | Military Health Care Provider | 159 Navsubase Nlon, Groton, CT 06349 | 2018-03-29 |
| 1013264423 | Dennis Buenaventura Custodio | Military Health Care Provider | 69 Trout Ave, Naval Undersea Medical Institute, Groton, CT 06349 | 2012-08-06 |
| 1609013549 | Nicolas David Mendoza | Military Health Care Provider | Uss Hawaii (ssn 776), Fpo, AE 06349 | 2009-01-14 |
| 1881843084 | Mark Francis Jarvis | Military Health Care Provider | Nssc Nlon, Bldg 76, Groton, CT 06349 | 2008-09-11 |
| 1780882738 | Michael Nutt | Military Health Care Provider | Bldg 517 Taugtog Ave, Navsubscol, Groton, CT 06349 | 2007-07-10 |
| 1497811343 | Keith Benjamin Hoekman | Nurse Practitioner | 1 Wahoo Dr, Groton, CT 06349 | 2006-12-28 |
| 1881604163 | Christina E Toufexis | Pediatrics | 1 Wahoo Drive, Groton, CT 06349 | 2006-08-09 |
| Find all providers in zip 06349 | ||||
| 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 |
|---|---|---|---|---|
| 1639581143 | Naval Health Clinic New England | Military/U.S. Coast Guard Pharmacy | 1 Wahoo Ave Bldg 449, Groton, CT 06349-2324 | 2014-06-02 |
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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.