375TH MEDICAL GROUP (NPI# 1417056037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417056037 |
| Entity Type | Organization |
| Organization Name | 375TH MEDICAL GROUP |
| Other Organization Name | SCOTT MAIN PHCY |
| Practice Address |
310 W Losey St Bldg 1530 Scott Afb IL 62225-5250 |
| Practice Telephone | 6182567345 |
| Practice Fax Number | 6182567131 |
| Mailing Telephone | 6182567345 |
| Mailing Fax Number | 6182567131 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2016-02-08 |
| 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 | 2024966 | 01 |
| Other Name | Type Code |
|---|---|
| SCOTT MAIN PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326147943 | 375th Medical Group | Pharmacy | Bldg 1680, Scott Afb, IL 62225 | 2006-09-21 |
| 1790190940 | 375th Medical Group | Military/U.S. Coast Guard Pharmacy | 310 W Losey St, Scott Afb, IL 62225-5250 | 2014-06-26 |
| 1073675955 | 375th Medical Group | Pharmacy | 310 W Losey St, Bldg 1530, Scott Afb, IL 62225-5250 | 2006-12-15 |
| 1851373161 | 375th Medical Group | Clinic/Center | 310 W Losey St, Scott Afb, IL 62225-5250 | 2005-11-14 |
| Street Address |
310 W LOSEY ST BLDG 1530 |
| City | SCOTT AFB |
| State | IL |
| Zip Code | 62225-5250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205839727 | Toney L Banks | Nurse Anesthetist, Certified Registered | 310 W Losey St, Scott Afb, IL 62225-5250 | 2005-05-30 |
| 1841814852 | Hilary Elizabeth Parsons | Student in an Organized Health Care Education/Training Program | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-06-04 |
| 1447874722 | Mauranda Nikki Bembry | Social Worker | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-06-03 |
| 1437778016 | Mark Alan Underhill | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-04-13 |
| 1194353276 | Kolin Daniel Cookson | Student in an Organized Health Care Education/Training Program | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-04-01 |
| 1831723592 | Linh Thuy Truong | Dentist | 310 W Losey St, Scott Afb, IL 62225-5250 | 2020-03-02 |
| 1346890894 | Crystal June Garcia | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-09-17 |
| 1740835602 | Andres Alejandro Paredes | Physician Assistant | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-08-07 |
| 1215580386 | Ryan Taylor Blalock | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-07-18 |
| 1063975001 | Collin Schroeder | Military Health Care Provider | 310 W Losey St, Scott Afb, IL 62225-5250 | 2019-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011645 | Cheryl D Jones | Registered Nurse | 375th Mdg, 310 W. Losey Street, Scott Afb, IL 62225 | 2020-04-13 |
| 1649836123 | Benjamin Truong | Student in an Organized Health Care Education/Training Program | Scott Air Force Base, 307 West Losey Street Building #1535, Apo, AA 62225 | 2019-05-10 |
| 1558925669 | Brian Ng | Student in an Organized Health Care Education/Training Program | South Drive, Scott Afb, Illinois, Apo, AA 62225 | 2019-04-24 |
| 1841853710 | Lance Scott Mcgavin | Student in an Organized Health Care Education/Training Program | 307 West Losey Street., Building #1535, Scott Afb, IL 62225 | 2019-04-17 |
| 1629503180 | Joshua Bryce Kessack | General Practice | 375 Amds, 310 Losey St, Scott Afb, IL 62225 | 2017-04-21 |
| 1265988059 | Jennifer Nicole Laurence | Dentist | 703 Seibert Rd Ste 5, Scott Afb, IL 62225 | 2016-08-31 |
| 1578940755 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 207 W. Winters St., Bldg 1981, Scott Afb, IL 62225 | 2015-04-27 |
| 1891193652 | Diana Meyer | Social Worker | Scott Afb, Apo, AA 62225 | 2014-12-10 |
| 1801210273 | Robie Victoria Hughes | Registered Nurse | 310 W Losey Street, Scott Air Force Base, IL 62225 | 2014-02-06 |
| 1487998746 | Melissa Dawn Goff | Military Health Care Provider | 310 West. Losey Street, Scott Afb, IL 62225 | 2012-11-26 |
| Find all providers in zip 62225 | ||||
| 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 |
|---|---|---|---|---|
| 1790190940 | 375th Medical Group | Military/U.S. Coast Guard Pharmacy | 310 W Losey St, Scott Afb, IL 62225-5250 | 2014-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942783246 | Blanchfield Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 110 Pharm Usa Health Clinic, Rock Island, IL 61299-0001 | 2018-09-12 |
| 1912313222 | Ireland Army Community Hospital | Military/U.S. Coast Guard Pharmacy | Bldg 110 Rodman Ave., Rock Island Arsenal, IL 61299-7240 | 2014-07-08 |
| 1043625981 | James A Lovell Fhcc | Military/U.S. Coast Guard Pharmacy | 2630 Green Bay Rd Bldg 3452, North Chicago, IL 60088-3303 | 2014-06-30 |
| 1164730602 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois Street, Great Lakes, IL 60088 | 2010-09-17 |
| 1598073439 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois St, Bldg 1007, Great Lakes, IL 60088 | 2010-09-14 |
| 1831406719 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 3440 Ohio St, Bldg 1017, Great Lakes, IL 60088-3155 | 2010-09-13 |
| 1790092674 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2630 Green Bay Rd, Bldg 3452, Great Lakes, IL 60088-3303 | 2010-09-13 |
| 1841405388 | Ireland Army Community Hospital | Military/U.S. Coast Guard Pharmacy | 110 Rodman Ave, Rock Island, IL 61299-0001 | 2007-05-10 |
| 1508965120 | James A Lovell Fhcc | Military/U.S. Coast Guard Pharmacy | 2470 Sampson St Bldg 237, Great Lakes, IL 60088-2942 | 2006-09-21 |
| 1336248962 | James A Lovell Fhcc | Military/U.S. Coast Guard Pharmacy | 3452 Greenbay Rd Bldg 3452, Great Lakes, IL 60088 | 2006-09-21 |
| Find all providers with the same taxonomy | ||||
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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.