WILLFORD HALL MEDICAL CTR (NPI# 1225137342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225137342 |
| Entity Type | Organization |
| Organization Name | WILLFORD HALL MEDICAL CTR |
| Other Organization Name | DOD POD EPHCY |
| Practice Address |
2200 Bergquist Dr Ste 1 Lackland Afb TX 78236-9908 |
| Practice Telephone | 2102925410 |
| Practice Fax Number | 2106703722 |
| Mailing Telephone | 2105366650 |
| Mailing Fax Number | 2106703722 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-20 |
| 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 | 2105569 | 01 |
| Other Name | Type Code |
|---|---|
| DoD OVERSEAS ePhcy | Doing Business As Name - Organization |
| DoD POD ePhcy | Doing Business As Name - Organization |
| LACKLAND MAIN OP PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790884856 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 6612, 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-5300 | 2006-09-22 |
| 1114026358 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | 2275 Reese St, Bldg 8410, Lackland Afb, TX 78236-1245 | 2006-09-22 |
| 1295834448 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | 2200 Bergquist Dr Ste 1, Bldg 4450, Lackland Afb, TX 78236-9908 | 2006-09-22 |
| 1316046550 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | 2200 Bergquist Dr Ste 1, Bldg 4450, Lackland Afb, TX 78236-9908 | 2006-09-22 |
| Street Address |
2200 BERGQUIST DR STE 1 |
| City | LACKLAND AFB |
| State | TX |
| Zip Code | 78236-9908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427041979 | Terence Gerald Benson Jr. | Pharmacist | 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-9908 | 2005-08-30 |
| 1972031011 | George Benson | General Practice | 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-9908 | 2017-06-02 |
| 1467984187 | Trevor Edgington | General Practice | 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-9908 | 2017-03-31 |
| 1376938399 | Colette Poole-boykin | Student in an Organized Health Care Education/Training Program | 2200 Bergquist Dr Ste 1, Ste 1, Lackland Afb, TX 78236-9908 | 2015-04-06 |
| 1720210933 | John Ryan Brewer | Ophthalmology | 2200 Bergquist Dr Ste 1, Attn: Credentials (cmc), Lackland Afb, TX 78236-9908 | 2009-08-20 |
| 1023256815 | Risa Cavalcanti Riepma | Dietitian, Registered | 2200 Bergquist Dr Ste 1, Attn: Credentials (cmc), Lackland Afb, TX 78236-9908 | 2009-02-02 |
| 1073767117 | Susan Wright Mongeau | Dentist | 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-9908 | 2008-11-14 |
| 1053571018 | Brian Michael Fitzgerald | Anesthesiology | 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-9908 | 2008-06-12 |
| 1760649297 | Rayna Lane Wooten | Dietitian, Registered | 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-9908 | 2008-05-21 |
| 1235309659 | Margaret Bonnie Cole | Pharmacist | 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-9908 | 2008-03-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063047363 | Arnoldo Arturo Gonzalez Jr. | Specialist/Technologist | 1033 Truemper St, Lackland Afb, TX 78236 | 2020-03-06 |
| 1023643343 | Meredith Grace Cockerell | Specialist/Technologist | W Military Drive, San Antonio, TX 78236 | 2020-03-06 |
| 1578120598 | Hali Rashelle Hall | Dentist | 1615 Truemper St, Blg 6418, Attn: 59ds/sgdn, Jbsa Lackland, TX 78236 | 2019-05-24 |
| 1952967077 | Paul Fianza Boseman | Nurse Practitioner | 1106 Wilford Hall Loop, San Antonio, TX 78236 | 2019-05-14 |
| 1689161978 | Kelly Jones Buckshire | Dentist | Dunn Dental Clinic, 1615 Truemper Rd, San Antonio, TX 78236 | 2018-04-23 |
| 1902308570 | Roger Louis Farney | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg. 4554, Jbsa Lackland Afb, TX 78236 | 2018-02-28 |
| 1568916856 | Thomas Maxwell Woolf | Dentist | 1100 Wilford Hall Ambulatory Surgical Center, Lackland Afb, TX 78236 | 2016-08-04 |
| 1831544956 | Michael Veronneau | Student in an Organized Health Care Education/Training Program | 59 Mdw/ge 1100 Wilford Hall Loop, Bldg. 4554, Jbsa Lackland, TX 78236 | 2016-04-26 |
| 1376906958 | David Kephart Jr. | General Practice | 1100 Wilford Hall Loop Bldg 4454, Jbsa Lackland, TX 78236 | 2016-04-01 |
| 1184084089 | Olivia Arballo | Dermatology | Wilford Hall Asc, Attn: Dept of Dermatology, 1100 Wilford Hall Loop Bldg 4554, Jbsa-lackland, TX 78236 | 2016-03-04 |
| Find all providers in zip 78236 | ||||
| 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 |
|---|---|---|---|---|
| 1790884856 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 6612, 2200 Bergquist Dr Ste 1, Lackland Afb, TX 78236-5300 | 2006-09-22 |
| 1114026358 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | 2275 Reese St, Bldg 8410, Lackland Afb, TX 78236-1245 | 2006-09-22 |
| 1063829414 | Wilford Hall Medical Center | Military/U.S. Coast Guard Pharmacy | 2275 Reese St, Lackland Afb, TX 78236-1245 | 2014-07-17 |
| 1295834448 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | 2200 Bergquist Dr Ste 1, Bldg 4450, Lackland Afb, TX 78236-9908 | 2006-09-22 |
| 1316046550 | Willford Hall Medical Ctr | Military/U.S. Coast Guard Pharmacy | 2200 Bergquist Dr Ste 1, Bldg 4450, Lackland Afb, TX 78236-9908 | 2006-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710532510 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 7800 W Ih 10 Ste 235, San Antonio, TX 78230-4768 | 2019-08-08 |
| 1508364258 | Wilford Hall Medical Center | Military/U.S. Coast Guard Pharmacy | 25615 Us Highway 281 N Ste 215, San Antonio, TX 78258-7135 | 2018-01-29 |
| 1831502590 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 2401 Scott Rd, Brooke Army Medical Center, Fort Sam Houston, TX 78234 | 2014-06-10 |
| 1124431317 | Carl R. Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | 4250 Clear Creek Rd, Room 406, Fort Hood, TX 76544-5095 | 2014-06-05 |
| 1134479413 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Torch St Rm C101, Bldg 21227, Ft Bliss, TX 79916 | 2012-09-14 |
| 1053618546 | Brooke Army Medical Center | Military/U.S. Coast Guard Pharmacy | 6501 Fm 3009, Suite 210, Schertz, TX 78154 | 2011-02-17 |
| 1740580125 | Carl R Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | 458 W Highway 190, Town Square Shopping Center, Copperas Cove, TX 76522-3904 | 2010-11-01 |
| 1477853851 | Carl R Darnall Army Medical Center | Military/U.S. Coast Guard Pharmacy | Market Heights Shopping Center 201 E., Central Texas Expressway, Harker Heights, TX 76548 | 2010-11-01 |
| 1891003000 | Carl R Darnall Amry Medical Center | Military/U.S. Coast Guard Pharmacy | 2245 761st Tank Bn, Bldg 2245, Fort Hood, TX 76544 | 2010-09-22 |
| 1962718726 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Haan Rd, Ste A-11 Bldg 1611, Ft Bliss, TX 79916 | 2010-08-31 |
| Find all providers with the same taxonomy | ||||
| City | LACKLAND AFB |
| Zip Code | 78236 |
Please comment or provide details below to improve the information on WILLFORD HALL MEDICAL CTR.
| 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.