92 MEDICAL GROUP/SGSL (NPI# 1801195110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801195110 |
| Entity Type | Organization |
| Organization Name | 92 MEDICAL GROUP/SGSL |
| Other Organization Name | FAIRCHILD ALT PHCY |
| Practice Address |
6955 22nd Ave Ne # 3401 Moses Lake WA 98837-3288 |
| Mailing Address |
701 Hospital Loop # 135 Fairchild Afb WA 99011-8704 |
| Practice Telephone | 5092471943 |
| Mailing Telephone | 2102218443 |
| Mailing Fax Number | 2102952567 |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2011-03-25 |
| Authorized Official Name | HECTOR MORALES (DEPUTY DIRECTOR OF PHARMAC Y OPS) |
| Authorized Official Telephone | 2102218443 |
| Is Organization Subpart | Y |
| Parent Organization Name | 92 MEDICAL GROUP/SGSL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| Other Name | Type Code |
|---|---|
| FAIRCHILD ALT PHCY | Doing Business As Name - Organization |
| Street Address |
6955 22ND AVE NE # 3401 |
| City | MOSES LAKE |
| State | WA |
| Zip Code | 98837-3288 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316447097 | Lateef Ajani Olaniyan | Pharmacist | 2709 W Broadway Avenue, Southgate Pharmacy, Moses Lake, WA 98837 | 2018-02-19 |
| 1982117651 | Amanda M Cross | Massage Therapist | 2200 S. Maiers Rd., Suite B, Moses Lake, WA 98837 | 2017-11-15 |
| 1962928200 | E & H Holdings, LLC | Family Medicine | 708 E Penn St, Moses Lake, WA 98837 | 2017-08-18 |
| 1912366881 | Tara L Zamarron | Nurse Practitioner | 1550 S. Pioneer Way, Samaritan Family Physicians, Moses Lake, WA 98837 | 2016-02-19 |
| 1124401732 | Christian Mmadibuobu Okafor | Dentist | 605 South Coolidge Street, Moses Lake Community Health Center, Moses Lake, WA 98837 | 2015-06-30 |
| 1790182004 | Tari Ann Devaney | Dental Hygienist | 605 Coolidge Drive, Moses Lake, WA 98837 | 2014-12-02 |
| 1356746150 | Anna Marie Peterson | Counselor | 814 S. Wilder St., Moses Lake, WA 98837 | 2014-10-23 |
| 1699119495 | Geoffrey T. Ping D.d.s. and Asia Dela Cruz D.d.s. Pllc | Dentist | 800 N. Stratford Rd., Moses Lake, WA 98837 | 2013-04-23 |
| 1831433325 | George Kenyon Exeter | Physical Therapy Assistant | 817 E Plum Ave, Moses Lake, WA 98837 | 2012-11-21 |
| 1114219698 | Sound Oxygen Service Inc | Durable Medical Equipment & Medical Supplies | 1010 S Pioneer Way Ste C, Moses Lake, WA 98837 | 2011-05-03 |
| Find all providers in zip 98837 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 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 |
| 1477652519 | 92nd Medical Group | Military/U.S. Coast Guard Pharmacy | 701 Hospital Loop # 135, Fairchild Afb, WA 99011-8704 | 2006-09-22 |
| Find all providers with the same taxonomy | ||||
| City | MOSES LAKE |
| Zip Code | 98837 |
Please comment or provide details below to improve the information on 92 MEDICAL GROUP/SGSL.
| 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.