27TH MEDICAL GROUP (NPI# 1285606384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285606384 |
| Entity Type | Organization |
| Organization Name | 27TH MEDICAL GROUP |
| Practice Address |
208 W Casablanca Ave 27 Mdss Sgsr Cannon Afb NM 88103-5009 |
| Practice Telephone | 5057844023 |
| Practice Fax Number | 5057847749 |
| Mailing Telephone | 5057844023 |
| Mailing Fax Number | 5057847749 |
| Enumeration Date | 2006-02-02 |
| 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 |
|---|---|---|---|
| NM | NCPDP | 3210185 | 01 |
| Street Address |
208 W CASABLANCA AVE 27 MDSS SGSR |
| City | CANNON AFB |
| State | NM |
| Zip Code | 88103-5009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396217170 | Nathanael Hand | Dietitian, Registered | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2018-12-18 |
| 1306228325 | Katherine Milam | Family Medicine | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2015-06-25 |
| 1295093912 | Desiree Anderson | Military Health Care Provider | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2012-05-01 |
| 1144504085 | Christopher Mclaughlin | Internal Medicine | 208 W Casablanca Ave, 27 Soamds, Cannon Afb, NM 88103-5009 | 2011-10-10 |
| 1649503806 | Fawn Nicole Jones | Social Worker | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2009-09-04 |
| 1912139668 | Jessica Marie Pothast | Pharmacist | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2009-08-13 |
| 1083844054 | Lindsay Vincent | Military Health Care Provider | 208 W Casablanca Ave, 27 Somdg, Cannon Afb, NM 88103-5009 | 2009-07-23 |
| 1639313125 | Andrew Springstead | Military Health Care Provider | 208 W Casablanca Ave, 27somdg, Cannon Afb, NM 88103-5009 | 2009-04-28 |
| 1366686842 | Steven Brandon Yates | Military Health Care Provider | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2009-04-28 |
| 1740426923 | Justin David Wright | Physician Assistant | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2008-12-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346747151 | Isabella Wolak | Pharmacist | 224 D L Ingram Blvd, Cannon Afb, NM 88103 | 2018-04-09 |
| 1225480544 | Stacey Tatro | Dentist | 224 West D.l. Ingram Ave., Bldg 1408, Cannon Afb, NM 88103 | 2016-07-11 |
| 1871965673 | Chad Bryan Carter | Dentist | 224 W Dl Ingram Ave, Sgpd/dental Clinic, Cannon Air Force Base, NM 88103 | 2015-10-20 |
| 1740660836 | Terah Clifford | Dental Hygienist | 224 W Dl Ingram Blvd, Bldg 1408 Dental Clinic, Cannon Afb, NM 88103 | 2015-06-03 |
| 1528452208 | Taylor Bottari | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2015-03-20 |
| 1588071328 | Gretchen Evelynn Szymanski | Nurse Practitioner | Cannon Afb, 224 W D.l. Ingram Blvd, Cannon Afb, NM 88103 | 2014-07-14 |
| 1396155206 | Jennifer Brynn Bendokas | Physician Assistant | 224 West Dl Ingram Avenue, Cannon Afb, NM 88103 | 2014-04-30 |
| 1366889487 | Jeremy Michael Strohmayer | General Practice | 511 Chindt Blvd Building 300, 27soss/osm, Cannon Afb, NM 88103 | 2013-05-30 |
| 1356622401 | Matthew John Nielsen | Dentist | 224 W D.l. Ingram, Bld. 1408, Cannon Afb, NM 88103 | 2011-09-02 |
| 1689965485 | Bryan Wade Sixkiller | Optometrist | 27th Somdg, 208 W. Casa Blanca Ave., Apo, AA 88103 | 2011-04-27 |
| Find all providers in zip 88103 | ||||
| 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 |
|---|---|---|---|---|
| 1629274105 | William Beaumont Army Medical Center | Clinic/Center | 525 Rock Island, White Sands, NM 88002 | 2007-06-22 |
| 1639382047 | William Beaumont Army Medical Center | Clinic/Center | 530 Rock Island Ave, White Sands Missile Range, NM 88002-1197 | 2007-05-08 |
| 1952546970 | William Beaumont Army Medical Center | Clinic/Center | 530 Rock Island Ave, Bldg 2 Tmc Mcgregor Range, White Sands Missile Range, NM 88002-1197 | 2008-12-04 |
| City | CANNON AFB |
| Zip Code | 88103 |
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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.