377TH MEDICAL GROUP (NPI# 1073610820) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073610820 |
| Entity Type | Organization |
| Organization Name | 377TH MEDICAL GROUP |
| Other Organization Name | KIRTLAND MAIN OP PHCY 377TH MDG |
| Practice Address |
2050a 2nd St Se Kirtland Afb NM 87117-5524 |
| Mailing Address |
377 Th Medical Group 3rd Party Collections 205a Second St Se Kirtland Afb NM 87117-0001 |
| Practice Telephone | 5058463130 |
| Mailing Telephone | 5058463130 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-06-22 |
| 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 | 2058180 | 01 |
| Other Name | Type Code |
|---|---|
| KIRTLAND MAIN OP PHCY 377TH MDG | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962501312 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | Gibson Blvd Bldg 20167, Albuquerque, NM 87108 | 2006-09-22 |
| 1912982810 | 377th Medical Group | Clinic/Center | 2050a Second St Se, Kirtland Afb, NM 87117-5524 | 2005-12-13 |
| 1740694553 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2014-06-19 |
| Street Address |
2050A 2ND ST SE |
| City | KIRTLAND AFB |
| State | NM |
| Zip Code | 87117-5524 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841273109 | Mylene Tran Huynh | Family Medicine | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2005-11-21 |
| 1295103265 | Adam David Myers | Physician Assistant | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2015-09-09 |
| 1184943623 | Todd Burbach | Military Health Care Provider | 2050a 2nd St Se, Kirtland Afb, NM 87117-5000 | 2010-05-24 |
| 1366671570 | William James Negri | Military Health Care Provider | 2050a 2nd St Se, 377amds/sgpf, Kirtland Afb, NM 87117-5522 | 2009-07-09 |
| 1316906993 | George Eric Womble | Registered Nurse | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2006-03-21 |
| 1114990280 | Mary Ann Terese Orzech | Preventive Medicine | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2006-02-09 |
| 1497739098 | Kenneth Egerstrom | Family Medicine | 2050a 2nd St Se, Kirtland Afb, NM 87117-5522 | 2005-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245614544 | Rowland Coyle | Military Health Care Provider | 701 Stephen Moody Rd, Albuquerque, NM 87117 | 2015-07-16 |
| 1649619511 | National Vision Optical | Technician/Technologist | 7901 Gibson Blvd, Bldg 20176, Kirtland, NM 87117 | 2013-06-24 |
| 1437493020 | Sarah Michael Workman | Nurse Practitioner | 1501 San Pedro Drive Se, Bld 47, 377mdg/mdos/sgow, Albuquerque, NM 87117 | 2012-11-20 |
| 1871852210 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | Kirtland Afb Building 20170, Albuquerque, NM 87117 | 2012-05-04 |
| 1528180502 | Gay C Davis | Speech-Language Pathologist | 25000 East Kirtland Afb, Wherry Es, Albuquerque, NM 87117 | 2007-04-03 |
| 1952493017 | Angela Marie Albrecht | Family Medicine | 377 Medical Group 2050 A Second St Se, Albuquerque, NM 87117 | 2006-09-28 |
| 1104930734 | Lesley Dale Pacheco | Social Worker | 2050 A 2nd Street, Kirtland Afb, NM 87117 | 2006-08-19 |
| 1053355735 | Joseph Agage Ouma | Family Medicine | 377th Mdg, Kirtland Afb, 2050 A Second St, Se, Albuquerque, NM 87117 | 2006-06-15 |
| 1033762927 | Mary Mauldin | Registered Nurse | 1515 Eubank Blvd, Albuquerque, NM 87117 | 2019-07-19 |
| 1811540834 | Angie Leigh Avila-quigley | Registered Nurse | 1515 Eubank, Albuquerque, NM 87117 | 2019-07-18 |
| Find all providers in zip 87117 | ||||
| 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 |
|---|---|---|---|---|
| 1952716896 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | 1363 Aberdeen Road, White Sands Missile Range, NM 88002-5520 | 2014-06-30 |
| 1316253297 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Hawk Rd, Rm 9503-11, Chaparrel, NM 88021 | 2010-08-30 |
| 1780783134 | William Beaumont Army Medical | Military/U.S. Coast Guard Pharmacy | Aberdeen Ave, Bldg 1363, White Sand Missile Range, NM 88002 | 2006-09-22 |
| 1962501312 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | Gibson Blvd Bldg 20167, Albuquerque, NM 87108 | 2006-09-22 |
| 1871692228 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103-5009 | 2006-09-22 |
| 1417356072 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W D L Ingram Blvd, Cannon Afb, NM 88103-5103 | 2014-08-20 |
| 1356755185 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St Bldg 15, Holloman Afb, NM 88330-8273 | 2014-06-19 |
| 1740694553 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2014-06-19 |
| 1023172772 | Cannon Refill Phcy | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103 | 2006-12-20 |
| 1982701736 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Holloman Afb, NM 88330-8273 | 2006-09-20 |
| Find all providers with the same taxonomy | ||||
| City | KIRTLAND AFB |
| Zip Code | 87117 |
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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.