3RD MEDICAL SUPPORT SQUADRON SGSL (NPI# 1295834356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295834356 |
| Entity Type | Organization |
| Organization Name | 3RD MEDICAL SUPPORT SQUADRON SGSL |
| Other Organization Name | ELMENDORF PHCY |
| Practice Address |
5955 Zeamer Ave Elmendorf Afb AK 99506-3702 |
| Practice Telephone | 9075801175 |
| Practice Fax Number | 9075801176 |
| Mailing Telephone | 9075801175 |
| Mailing Fax Number | 9075801176 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-06-15 |
| 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 | 1996975 | 01 |
| Other Name | Type Code |
|---|---|
| ELMENDORF PHCY | Doing Business As Name - Organization |
| Street Address |
5955 ZEAMER AVE |
| City | ELMENDORF AFB |
| State | AK |
| Zip Code | 99506-3702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386261642 | Michael Joseph Del Grande | Pharmacist | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2020-07-01 |
| 1154946440 | Tommi Alana Heim | Physical Therapy Assistant | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2020-06-11 |
| 1386118545 | Ryan Spencer Rowe | Registered Nurse | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2019-01-21 |
| 1417300799 | Thomas B Williams | Physician Assistant | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2016-07-21 |
| 1699139824 | Benjamin Barringer | General Practice | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2016-04-13 |
| 1790150126 | James B Mcdonald | Physician Assistant | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2015-12-10 |
| 1760862155 | William Harjes | Radiology | 5955 Zeamer Ave, Jber Hospital - Diagnostic Radiology, Elmendorf Afb, AK 99506 | 2015-06-01 |
| 1053707257 | Sara Larosa | Anesthesiology | 5955 Zeamer Ave, Elmendorf Afb, AK 99506 | 2015-04-14 |
| 1942695556 | Calen Wade Kucera | Obstetrics & Gynecology | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2015-03-31 |
| 1215355037 | Andrew Paul Polito | Internal Medicine | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2014-03-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538797279 | Mark Pulver | Social Worker | 673mdg, Zeamer Avenue, Joint Base Elmendorf-richardson, AK 99506 | 2020-03-30 |
| 1871052837 | Ryan Kenny Zarnowski | Dentist | 673 Mdg, 5955 Zeamer Avenue, Jber, Ak 99506, Apo, AA 99506 | 2019-03-18 |
| 1679056659 | Bennett Robert Stadler | Physician Assistant | 673 Mdg 5955 Zeamer Avenue, Jber, AK 99506 | 2018-09-14 |
| 1437678687 | Mary Ann Barnard | Nurse Practitioner | Joint Base Elmendorf-richardson Hospital, 5955 Zeamer Ave, Anchorage, AK 99506 | 2017-09-19 |
| 1205375698 | Kuuipo Lau | Social Worker | 673d Mdg, 5955 Zeamer Ave., Jber, AK 99506 | 2017-02-17 |
| 1427434315 | Vance Knauer | Dentist | 673mdg 5955 Zeamer Ave, Jber, AK 99506 | 2015-08-03 |
| 1295112159 | Jacob Eby | Pediatrics | 673 Mdg 5955 Zeamer Ave, Jber, AK 99506 | 2015-04-29 |
| 1174956338 | Scott M Cheney | Physical Therapist | 673mdg, 5955 Zeamer Ave, Jber, AK 99506 | 2013-08-12 |
| 1518305580 | Jennifer Lynn Robison | Physician Assistant | 65955 Zeamer Avenue, Jber, AK 99506 | 2013-06-12 |
| 1588939664 | Paul Aaron Garrett | Emergency Medicine | 673rd Mdg, 5955 Zeamer Avenue, Jber, Apo, AA 99506 | 2012-03-21 |
| Find all providers in zip 99506 | ||||
| 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 |
|---|---|---|---|---|
| 1568446524 | 673rd Medical Group Sgsr | Military/U.S. Coast Guard Pharmacy | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2005-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427217447 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 131dg 661 Artic Ave, Fr Greely, AK 99731 | 2008-06-05 |
| 1104925262 | Us Coast Guard Finance Center | Military/U.S. Coast Guard Pharmacy | Bldg N46 Isc Kodiak, Kodiak, AK 99619 | 2006-09-22 |
| 1306945464 | 354th Medical Group Mdg | Military/U.S. Coast Guard Pharmacy | Bldg 3349 Central Ave, Eielson Afb, AK 99702 | 2006-09-22 |
| 1013016179 | Us Coast Guard Finance Center | Military/U.S. Coast Guard Pharmacy | 1300 Stedman Stisc Ketchikan, Ketchikan, AK 99901 | 2006-09-22 |
| 1053418806 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 1060 Gaffney Rd Stop 7420, Bldg 4065, Ft Wainwright, AK 99703-5007 | 2006-09-20 |
| 1821402652 | 673rd Medical Group Joint Base Elmendorf-richardson | Military/U.S. Coast Guard Pharmacy | 5955 Zeamer Ave, 673rd Medical Group, Jber, AK 99506-3702 | 2014-06-19 |
| 1295149383 | Bassett Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bassett Army Community Hospital, Meddac-alaska 1060 Gaffney Rd #7400, Ft. Wainwright, AK 99703-7400 | 2014-06-17 |
| 1629481486 | 673rd Medical Group Joint Base Elmendorf-richardson Jber | Military/U.S. Coast Guard Pharmacy | 5800 Westover Ave, Jber, AK 99506-1603 | 2014-06-09 |
| 1902218415 | 354 Mdg | Military/U.S. Coast Guard Pharmacy | 2630 Central Ave Ste 1m07, Eielson Afb, AK 99702-2325 | 2014-06-02 |
| 1285948877 | Hswl Fo Kodiak Det Ketchikan | Military/U.S. Coast Guard Pharmacy | 1300 Stedman St, Ketchikan, AK 99901-6661 | 2010-08-06 |
| Find all providers with the same taxonomy | ||||
| City | ELMENDORF AFB |
| Zip Code | 99506 |
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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.