62ND MED GRP (NPI# 1366541401) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366541401 |
| Entity Type | Organization |
| Organization Name | 62ND MED GRP |
| Other Organization Name | MCCHORD MAIN PHCY |
| Practice Address |
690 Barnes Blvd Mcchord Afb WA 98438-1303 |
| Practice Telephone | 2539822474 |
| Practice Fax Number | 2539828401 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2009-09-01 |
| Authorized Official Name | HECTOR MORALES (MGR PHRMCY OPERATIONS CNTR) |
| Authorized Official Telephone | 2102218443 |
| Is Organization Subpart | Y |
| Parent Organization Name | 62ND MED GRP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER ID NUMBER-COMMERCIAL NUMBER | 4927197 | 01 |
| Other Name | Type Code |
|---|---|
| MCCHORD MAIN PHCY | Doing Business As Name - Organization |
| Street Address |
690 BARNES BLVD |
| City | MCCHORD AFB |
| State | WA |
| Zip Code | 98438-1303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891247706 | Air Force | Military Health Care Provider | 690 Barnes Blvd, Mcchord Afb, WA 98438-0000 | 2016-10-26 |
| 1164750998 | Jeanne Chavey Morrow | Social Worker | 690 Barnes Blvd, Mcchord Afb, WA 98438-1303 | 2009-12-07 |
| 1609023274 | Madigan Army Medical Ctr | Clinic/Center | 690 Barnes Blvd, Mcchord Afb, WA 98438-1303 | 2008-08-26 |
| 1871602136 | Carolyn Kay Pittenger | Registered Nurse | 690 Barnes Blvd, 62nd Mdg, Mcchord Afb, WA 98438-1303 | 2006-08-30 |
| 1447288428 | Michael Daniel Jones | Psychologist | 690 Barnes Blvd, Mcchord Afb, WA 98438 | 2006-06-29 |
| 1952345696 | Jeff Brittain | Pharmacist | 690 Barnes Blvd, Mcchord Afb, WA 98438 | 2006-06-15 |
| 1801837398 | 62 Medical Group | Clinic/Center | 690 Barnes Blvd, Attn: Sghc, Mcchord Afb, WA 98438 | 2006-06-08 |
| 1811954811 | Vickie Knight | Registered Nurse | 690 Barnes Blvd, Mcchord Afb, WA 98438 | 2006-04-26 |
| 1992761290 | Sherri Ann Cote | Registered Nurse | 690 Barnes Blvd, Mcchord Afb, WA 98438 | 2006-04-25 |
| 1992761787 | Kathy Wainscott Berger | Registered Nurse | 690 Barnes Blvd, 62 Mdos/sgol, Mcchord Afb, WA 98374 | 2006-04-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457810483 | Roveds Kaarins | Nursing Care | Mcchord Air Force Base Clinic, 690 Barnes Blvd Jblm Lakewood Wa, Apo, AA 98438 | 2019-03-19 |
| 1326459843 | Dr Larsen Eye Care Inc | Optometrist | 504 A St Mcchord Main Exchange, Ft. Lewis Mcchord Afb, WA 98438 | 2014-05-19 |
| 1548580392 | Kevin Lok | Family Medicine | 600 Barnes Blvd., Mcchord Medical Clinic, Jblm, WA 98438 | 2010-06-03 |
| 1720205578 | Nathan Kane Fosmore | Registered Nurse | Us Dept of The Us Airforce, 690 Barnes Blvd, Mcchord Afb, WA 98438 | 2007-04-20 |
| 1225176951 | Ronald Richardson Morris | Family Medicine | 690 Barnes Road, Mcchord Medical Clinic Fam Med Clinic, Joint Base Lewis Mcchord, WA 98438 | 2007-02-02 |
| 1770527418 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | A Street Bldg 504, Mcchord Afb, WA 98438 | 2006-06-15 |
| 1982660692 | Shanti Jones | Registered Nurse | 62nd Med Group, 690 Barnes Ave, Mcchord Afb, WA 98438 | 2006-04-21 |
| 1578547436 | Cynthia Lee Fry-spray | Physician Assistant | 691 Barnes Blvd, Mcchord Afb, WA 98438 | 2005-12-05 |
| 1366432171 | Robert Dean Rock | Dentist | 527 Barnes Blvd, Mcchord Air Forse Base Dental Clinic, Mcchord, WA 98438 | 2005-10-24 |
| 1457344913 | Norman Harris | Dentist | 62mdos/sgod 690 Barnes Blvd., Mcchord Afb, WA 98438 | 2005-08-30 |
| Find all providers in zip 98438 | ||||
| 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 |
|---|---|---|---|---|
| 1043270549 | 62d Medical Group Usaf | Military/U.S. Coast Guard Pharmacy | 690 A St, Mcchord Afb, WA 98438-1303 | 2006-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528488848 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Madigan Army Medical Ctr 9040, Jackson Ave, Tacoma, WA 98431-1100 | 2014-04-25 |
| 1518387836 | Naval Health Clinic Oak Harbor | Military/U.S. Coast Guard Pharmacy | Naval Hospital Oak Hbr 3475 N Saratoga St, Oak Harbor, WA 98278-8800 | 2014-04-25 |
| 1205102761 | 92nd Medical Group | Military/U.S. Coast Guard Pharmacy | 103 Saatz Rd, Fairchild Afb, WA 99011 | 2012-03-29 |
| 1801195110 | 92 Medical Group/sgsl | Military/U.S. Coast Guard Pharmacy | 6955 22nd Ave Ne, # 3401, Moses Lake, WA 98837-3288 | 2011-03-25 |
| 1316243744 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | 10507 156th St E, Suite 112, Puyallup, WA 98374-9361 | 2011-02-02 |
| 1992804033 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 2202, Ft Lewis, WA 98433 | 2006-09-22 |
| 1275632317 | 92nd Medical Group | Military/U.S. Coast Guard Pharmacy | Bldg 2460, Fairchild Afb, WA 99011 | 2006-09-22 |
| 1609975747 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Bldg 9040a, Tacoma, WA 98431-0001 | 2006-09-22 |
| 1336248475 | Pt Angeles Uscg Phcy | Military/U.S. Coast Guard Pharmacy | Ediz Hook Rd, Port Angeles, WA 98362 | 2006-09-22 |
| 1619076650 | Madigan Army Medical Ctr | Military/U.S. Coast Guard Pharmacy | Jackson Ave Bldg 9040a, Tacoma, WA 98431-0001 | 2006-09-22 |
| Find all providers with the same taxonomy | ||||
| City | MCCHORD AFB |
| Zip Code | 98438 |
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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.