56TH MEDICAL GROUP (NPI# 1194700971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194700971 |
| Entity Type | Organization |
| Organization Name | 56TH MEDICAL GROUP |
| Other Organization Name | LUKE AFB MTF |
| Practice Address |
7219 N Litchfield Rd Luke Afb AZ 85309 |
| Practice Telephone | 6238564057 |
| Mailing Telephone | 6238564057 |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2014-03-03 |
| Authorized Official Name | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Authorized Official Telephone | 7036817613 |
| 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 |
|---|---|---|---|
| AZ | NCPDP | 0323953 | 01 |
| Other Name | Type Code |
|---|---|
| Luke AFB MTF | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043627631 | 56th Medical Group | Military/U.S. Coast Guard Pharmacy | 7219 N Litchfield Rd Bldg 1130, Luke Afb, AZ 85309-1529 | 2014-07-16 |
| Street Address |
7219 N LITCHFIELD RD |
| City | LUKE AFB |
| State | AZ |
| Zip Code | 85309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740281203 | Scott Joseph Lafont | Dentist | 7219 N Litchfield Rd, Dental Clinic, Luke Afb, AZ 85309-1529 | 2005-08-09 |
| 1184262347 | Denise Renee Covert | Nurse Practitioner | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2019-12-18 |
| 1790279685 | Tyler John Gale | Nurse Practitioner | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2018-06-14 |
| 1679091706 | Patrick Andrew Stockton | Nurse Practitioner | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2017-09-09 |
| 1417483074 | Matthew Collins | Military Health Care Provider | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2017-05-02 |
| 1235672114 | Noah Russell | Physician Assistant | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2016-11-28 |
| 1811340565 | Collin Urbanowicz | Physician Assistant | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2016-07-18 |
| 1972986909 | Kristin Haskell | Advanced Practice Midwife | 7219 N Litchfield Rd, Luke Afb, AZ 85309-1529 | 2015-07-08 |
| 1720402993 | Samuel Beck | Pediatrics | 7219 N Litchfield Rd, Luke Afb, AZ 85309 | 2014-02-09 |
| 1760820989 | Bryan Geoffrey Anderson | General Practice | 7219 N Litchfield Rd, 56 Amds (bldg 810), Luke Afb, AZ 85309-1529 | 2013-06-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912466111 | Natalie Ann Korona | Nurse Practitioner | 56 Mdg/mdos/sgof, 7219 N. Litchfield Rd, Luke Afb, AZ 85309 | 2019-03-18 |
| 1558647024 | Cheng Chung Tsai | Pharmacist | 72 19 N Litchfield Road, 56 Medical Group, Luke Afb, AZ 85309 | 2011-10-28 |
| 1053617464 | Bradley William Snyder | Military Health Care Provider | 7224 North 139th Avenue, Glendale, AZ 85309 | 2011-02-02 |
| 1043516610 | Charles Delvon Pickett | Military Health Care Provider | 7019 N Litchfield Ave, Luke Afb, 56/amds, Luke Afb, AZ 85309 | 2011-01-31 |
| 1104980663 | Maurice Edgar Young | Obstetrics & Gynecology | 56th Aerospace Medicine Squadron, Luke Afb, AZ 85309 | 2006-12-20 |
| 1679658538 | Wayne Allen Beaver | Psychologist | Luke Air Force Base, Bldg 317, Glendale, AZ 85309 | 2006-10-26 |
| 1306945472 | 56th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | Bldg 810, Luke Afb, AZ 85309 | 2006-09-22 |
| 1679676571 | Anita Glenn-reller | Counselor | 317 Lightning Ave, Luke Afb, AZ 85309 | 2006-09-06 |
| 1346784881 | Kaleigh Moses | Registered Nurse | 13960 W Eagle St, Luke Air Force Base, AZ 85309-1426 | 2016-12-16 |
| 1376893511 | Melissa Ann Parra | Dentist | 7219 N Litchfield Rd., 56th Medical Group, Luke Afb, AZ 85309-1525 | 2012-09-14 |
| Find all providers in zip 85309 | ||||
| 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 |
|---|---|---|---|---|
| 1306049895 | Raymond W. Bliss Army Health Center | Clinic/Center | 45005 Arizona Street, Fort Huachuca, AZ 85613 | 2007-06-11 |
| 1508069527 | Naval Hospital Camp Pendleton | Clinic/Center | Bldg 1175, Yuma, AZ 85369 | 2007-06-07 |
| 1588635098 | Usa Meddac,rwbahc | Clinic/Center | 2240 Winrow Rd, Ft Huachuca, AZ 85613-5080 | 2006-02-01 |
| 1346455391 | Weed Army Community Hospital | Clinic/Center | 301 C St, Bldg 990, Yuma, AZ 85365-9498 | 2007-05-12 |
| 1811960149 | Raymond W. Bliss Health Cemter | Clinic/Center | 2240 E. Winrow Ave., Meddac, Ft. Huachuca, AZ 85613 | 2006-02-08 |
| 1083685507 | Raymond W. Bliss Army Health Center | Clinic/Center | 2240 E. Winrow Ave, Usa Meddac, Rwbahc, Fort Huachuca, AZ 85613-7079 | 2006-02-01 |
| 1558332080 | Raymond W Bliss Army Health Center | Clinic/Center | 2240 Winrow Rd, Ft Huachuca, AZ 85613-5080 | 2006-02-01 |
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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.