90TH MEDICAL GROUP-UNITED STATES AIR FORCE (NPI# 1578979688) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578979688 |
| Entity Type | Organization |
| Organization Name | 90TH MEDICAL GROUP-UNITED STATES AIR FORCE |
| Other Organization Name | DOD FE WARREN EPHCY |
| Practice Address |
6900 Alden Dr Fe Warren Afb WY 82005-3906 |
| Mailing Address |
90th Medical Group-united States Air Force 6900 Alden Dr. Fe Warren Afb WY 82005-3906 |
| Practice Telephone | 3077733636 |
| Practice Fax Number | 3077734589 |
| Mailing Telephone | 3077733636 |
| Mailing Fax Number | 3077734589 |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2016-01-22 |
| 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 | 2146759 | 01 |
| Other Name | Type Code |
|---|---|
| DoD FE WARREN ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609859826 | 90th Medical Group-united States Air Force | Military/U.S. Coast Guard Pharmacy | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2005-11-22 |
| Street Address |
6900 ALDEN DR |
| City | FE WARREN AFB |
| State | WY |
| Zip Code | 82005-3906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457990863 | Vivian Colette Tran | Pharmacist | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2020-01-02 |
| 1275096737 | Richard K Newman | Student in an Organized Health Care Education/Training Program | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2019-04-11 |
| 1952806069 | Jodi Lynn Keithley | Dietitian, Registered | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2018-03-29 |
| 1437675949 | Thomas Charles Ingersoll Jr. | Physician Assistant | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2017-08-16 |
| 1730619446 | Lauren Joann Redlinger | Family Medicine | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2017-06-14 |
| 1427421312 | Rebecca Dawn Ishola | Registered Nurse | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2015-11-02 |
| 1679953640 | Mary Frances Macleod | Pediatrics | 6900 Alden Dr, Fe Warren Afb, WY 82005 | 2015-06-04 |
| 1497144612 | Kelly Smerling | Nurse Practitioner | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2015-01-12 |
| 1407289069 | James Henry Barry Jr. | Pediatrics | 6900 Alden Dr, Fe Warren Afb, WY 82005-2945 | 2013-08-18 |
| 1801183579 | Ryan Patrick Voth | Psychiatry & Neurology | 6900 Alden Dr, Attn: 90 Mdos/sgoz Flight Med, Fe Warren Afb, WY 82005-3906 | 2011-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285250597 | Brittany Corrin Souder | Military Health Care Provider | 1600 Aldene Drive, Fe Warren Afb, WY 82005 | 2020-06-23 |
| 1093368110 | Aaron Michael Keating | Student in an Organized Health Care Education/Training Program | Mental Health Clinic, 90th Omrs, Fe Warren Clinic, Fe Warren Afb, WY 82005 | 2019-07-17 |
| 1477643823 | Paul Hoon Kim | Dentist | 90 Mdos, 6900 Alden Dr, F.e. Warren Afb, WY 82005 | 2006-10-14 |
| 1568495315 | Joseph Myles Simpson, Jr. | Dentist | F E Warren Air Force Base Dental Clinic, 6900 Alden Drive, Cheyenne, WY 82005 | 2006-07-07 |
| 1306864632 | Lisa Sung Eun Lee | Pharmacist | 6900 Alden Drive, Fe Warren Afb, WY 82005 | 2006-07-17 |
| 1992957252 | Perala Enterprises, LLC | Eyewear Supplier (Equipment, not the service) | 6207 Missile Dr, Building 722, Ft Warren Afb, WY 82005-2407 | 2008-10-17 |
| 1972157808 | James Turvy | Dentist | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-2945 | 2019-07-29 |
| 1245478676 | Denise E Campbell | Nutritionist | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-3906 | 2009-01-22 |
| 1255837332 | Robert Usher Wright Jr. | General Practice | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-3906 | 2018-04-05 |
| 1396018982 | Ryan Christopher Reynolds | Pharmacist | 6900 Alden Dr Bldg 160, Fe Warren Afb, WY 82005-3906 | 2012-02-14 |
| Find all providers in zip 82005 | ||||
| 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 |
|---|---|---|---|---|
| 1578662516 | 90th Medical Group | Military/U.S. Coast Guard Pharmacy | 6900 Alden Dr, Bldg 160, Fe Warren Afb, WY 82005-3906 | 2006-09-22 |
| 1609859826 | 90th Medical Group-united States Air Force | Military/U.S. Coast Guard Pharmacy | 6900 Alden Dr, Fe Warren Afb, WY 82005-3906 | 2005-11-22 |
| City | FE WARREN AFB |
| Zip Code | 82005 |
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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.