97TH MEDICAL GROUP (NPI# 1093782880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093782880 |
| Entity Type | Organization |
| Organization Name | 97TH MEDICAL GROUP |
| Practice Address |
301 N 1st St Bldg 46 Altus Afb OK 73523-5004 |
| Practice Telephone | 5804815400 |
| Practice Fax Number | 5804815416 |
| Mailing Telephone | 5804815400 |
| Mailing Fax Number | 5804815416 |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2010-11-15 |
| Authorized Official Name | SERENA LYNN HANSKEN (AIR FORCE UNIFORM BUSINESS OFFICE) |
| Authorized Official Telephone | 7035886419 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | NCPDP | 3720225 | 01 |
| Street Address |
301 N 1ST ST BLDG 46 |
| City | ALTUS AFB |
| State | OK |
| Zip Code | 73523-5004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053789875 | Sunnye Elizabeth Cope | Social Worker | 301 N 1st St, Altus Afb, OK 73523-5004 | 2015-09-10 |
| 1063894467 | Katelin Elise Kehoe | General Practice | 301 N 1st St, Altus Afb, OK 73523-5004 | 2015-06-22 |
| 1679968127 | Rebecca Leigh Parrish | Pediatrics | 301 N 1st St, Altus Afb, OK 73523 | 2015-04-01 |
| 1104231299 | Shelley Raska | Family Medicine | 301 N 1st St, Altus Afb, OK 73523-5004 | 2014-06-26 |
| 1598177370 | Department of Defense-air Force | Pharmacy | 301 N 1st St, Bldg 46, Altus Afb, OK 73523-5004 | 2014-05-28 |
| 1306174784 | Nguyen T Nguyen | Pharmacist | 301 N 1st St, Altus Afb, OK 73523-5004 | 2009-11-24 |
| 1528393626 | Christina S Hong | Pharmacist | 301 N 1st St, Altus Afb, OK 73523-5004 | 2009-10-07 |
| 1336246180 | Altus Phcy 97th Mdg | Pharmacy | 301 N 1st St, Altus Afb, OK 73523-5004 | 2006-09-20 |
| 1801856182 | Elaine Jean Tallorin | Dentist | 301 N 1st St, Altus Afb, OK 73523-5004 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629440920 | Jessica D'andrea | Psychologist | 209 E Sir Dr., Altus, OK 73523-0000 | 2015-10-26 |
| 1528449642 | Matthew Albright | Family Medicine | 301 N 1st St # 46, Altus, OK 73523-5004 | 2015-06-15 |
| 1093924441 | Wayne Joseph Merback | Pediatrics | 301 N 1st St Bldg 46, Altus Afb, OK 73523-5004 | 2007-05-22 |
| 1366934523 | Andrew James Dimond | Psychologist | 301 N 1st St # 46, Altus, OK 73523-5004 | 2018-06-04 |
| 1578743217 | Jessica Audrey Lotridge | Family Medicine | 301 N 1st St Bldg 46, Altus Afb, OK 73523-5004 | 2007-11-09 |
| 1528204559 | Ryan Luther Buhite | Psychologist | 301 N First Street, 97 Mdos/sgow Bldg 46, Altus Afb, OK 73523-5005 | 2008-12-22 |
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912377649 | Reynolds Army Community Hospital | Clinic/Center | 3161 Hoskins Rd, Fort Sill, OK 73503-4462 | 2015-10-07 |
| 1740650464 | Reynolds Army Community Hospital | Clinic/Center | 3445 Koehler Loop, Fort Sill, OK 73503-6008 | 2015-10-07 |
| 1932480068 | Reynolds Army Community Hospital | Clinic/Center | 2640 Miner Rd, Fort Sill, OK 73503 | 2011-09-02 |
| 1427208008 | Reynolds Army Community Hospital | Clinic/Center | 2913 Craig Road, Fort Sill, OK 73503 | 2008-09-19 |
| 1760688220 | Reynolds Army Community Hospital | Clinic/Center | 2862 Craig Road, Fort Sill, OK 73503 | 2007-06-22 |
| 1881890358 | Reynolds Army Community Hospital | Clinic/Center | 605 Randolph Road, Fort Sill, OK 73503 | 2007-06-22 |
| 1699971143 | Reynolds Army Community Hospital | Clinic/Center | 6037 Bessinger Street, Fort Sill, OK 73503 | 2007-06-22 |
| 1821318668 | Reynolds Army Community Hospital | Clinic/Center | 5404 Sw Lee Blvd, Frontier Medical Home-sill, Lawton, OK 73505-9695 | 2010-06-03 |
| 1083810550 | Reynolds Army Community Hospital | Clinic/Center | 4301 Mow Way Road, Fort Sill, OK 73503 | 2007-06-22 |
| 1124234364 | Reynolds Army Community Hospital | Clinic/Center | 4301 Mow Way Road, Sgt Bleak Troop Medical Clinic, Fort Sill, OK 73503 | 2007-05-15 |
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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.