ALTUS PHCY 97TH MDG (NPI# 1336246180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336246180 |
| Entity Type | Organization |
| Organization Name | ALTUS PHCY 97TH MDG |
| Other Organization Name | ALTUS PHCY 97TH MDG |
| Practice Address |
301 N 1st St Altus Afb OK 73523-5004 |
| Practice Telephone | 5804815258 |
| Practice Fax Number | 5804817420 |
| Mailing Telephone | 5804815258 |
| Mailing Fax Number | 5804817420 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-02-27 |
| 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 |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2074861 | 01 |
| Other Name | Type Code |
|---|---|
| ALTUS PHCY 97TH MDG | Doing Business As Name - Organization |
| Street Address |
301 N 1ST ST |
| 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 |
| 1801856182 | Elaine Jean Tallorin | Dentist | 301 N 1st St, Altus Afb, OK 73523-5004 | 2006-03-23 |
| 1093782880 | 97th Medical Group | Military/U.S. Coast Guard Pharmacy | 301 N 1st St, Bldg 46, Altus Afb, OK 73523-5004 | 2006-03-01 |
| 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 | 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 |
|---|---|---|---|---|
| 1093782880 | 97th Medical Group | Military/U.S. Coast Guard Pharmacy | 301 N 1st St, Bldg 46, Altus Afb, OK 73523-5004 | 2006-03-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457654766 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Custer Road, Bldg 2913, Fort Sill, OK 73503 | 2010-12-08 |
| 1831298017 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Macomb Rd Bldg 1719, Ft Sill, OK 73503 | 2006-09-22 |
| 1740389923 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Thomas Rd Bldg 6043 Tmc2, Ft Sill, OK 73503 | 2006-09-22 |
| 1194824458 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Reynolds Comm Hosp Dept of Phcy, 4300 Thomas St Bldg 4300, Ft Sill, OK 73503 | 2006-09-22 |
| 1982703245 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Us Army Health Clinic Aar Mcalester, Ic Tree Road, Mcalester, OK 74301-5000 | 2006-09-22 |
| 1245337096 | 72 Nd Medical Group | Military/U.S. Coast Guard Pharmacy | 5700 Arnold St Bldg 5801, Tinker Afb, OK 73145-8105 | 2006-09-20 |
| 1801871371 | 72d Medical Group | Military/U.S. Coast Guard Pharmacy | 5700 Arnold St., Tinker Afb, OK 73145-8012 | 2005-12-07 |
| 1962818336 | 71 Mdg Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 527 Gott Rd, Enid, OK 73705-5103 | 2014-07-07 |
| 1568877702 | Department of The Air Force 72d Medical Group | Military/U.S. Coast Guard Pharmacy | 7050 Air Depot Blvd, Tinker Afb, OK 73145-8716 | 2014-06-26 |
| 1225442056 | Reynolds Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 4301 Wilson St, Reynolds Army Community Hospital, Fort Sill, OK 73503-4472 | 2014-06-19 |
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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.