27TH MEDICAL GROUP SGSL (NPI# 1871692228) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871692228 |
| Entity Type | Organization |
| Organization Name | 27TH MEDICAL GROUP SGSL |
| Other Organization Name | CANNON MAIN PHCY |
| Practice Address |
208 W Casablanca Ave Bldg 1400 Cannon Afb NM 88103-5009 |
| Practice Telephone | 5757844028 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-06-12 |
| 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 | 2058697 | 01 |
| Other Name | Type Code |
|---|---|
| CANNON MAIN PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417356072 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W D L Ingram Blvd, Cannon Afb, NM 88103-5103 | 2014-08-20 |
| Street Address |
208 W CASABLANCA AVE BLDG 1400 |
| City | CANNON AFB |
| State | NM |
| Zip Code | 88103-5009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497999684 | Francisco S Deguzman | Military Health Care Provider | 208 W Casablanca Ave Bldg 1400, 27 Somdg - Osm, Cannon Afb, NM 88103-5009 | 2009-05-01 |
| 1558504068 | Logan D Jones | Preventive Medicine | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103-5009 | 2009-04-14 |
| 1023172772 | Cannon Refill Phcy | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103 | 2006-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346747151 | Isabella Wolak | Pharmacist | 224 D L Ingram Blvd, Cannon Afb, NM 88103 | 2018-04-09 |
| 1225480544 | Stacey Tatro | Dentist | 224 West D.l. Ingram Ave., Bldg 1408, Cannon Afb, NM 88103 | 2016-07-11 |
| 1871965673 | Chad Bryan Carter | Dentist | 224 W Dl Ingram Ave, Sgpd/dental Clinic, Cannon Air Force Base, NM 88103 | 2015-10-20 |
| 1740660836 | Terah Clifford | Dental Hygienist | 224 W Dl Ingram Blvd, Bldg 1408 Dental Clinic, Cannon Afb, NM 88103 | 2015-06-03 |
| 1528452208 | Taylor Bottari | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2015-03-20 |
| 1588071328 | Gretchen Evelynn Szymanski | Nurse Practitioner | Cannon Afb, 224 W D.l. Ingram Blvd, Cannon Afb, NM 88103 | 2014-07-14 |
| 1396155206 | Jennifer Brynn Bendokas | Physician Assistant | 224 West Dl Ingram Avenue, Cannon Afb, NM 88103 | 2014-04-30 |
| 1366889487 | Jeremy Michael Strohmayer | General Practice | 511 Chindt Blvd Building 300, 27soss/osm, Cannon Afb, NM 88103 | 2013-05-30 |
| 1356622401 | Matthew John Nielsen | Dentist | 224 W D.l. Ingram, Bld. 1408, Cannon Afb, NM 88103 | 2011-09-02 |
| 1689965485 | Bryan Wade Sixkiller | Optometrist | 27th Somdg, 208 W. Casa Blanca Ave., Apo, AA 88103 | 2011-04-27 |
| Find all providers in zip 88103 | ||||
| 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 |
|---|---|---|---|---|
| 1417356072 | 27th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 208 W D L Ingram Blvd, Cannon Afb, NM 88103-5103 | 2014-08-20 |
| 1023172772 | Cannon Refill Phcy | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave Bldg 1400, Cannon Afb, NM 88103 | 2006-12-20 |
| 1285606384 | 27th Medical Group | Military/U.S. Coast Guard Pharmacy | 208 W Casablanca Ave, 27 Mdss Sgsr, Cannon Afb, NM 88103-5009 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952716896 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | 1363 Aberdeen Road, White Sands Missile Range, NM 88002-5520 | 2014-06-30 |
| 1316253297 | William Beaumont Army Medical Center | Military/U.S. Coast Guard Pharmacy | Hawk Rd, Rm 9503-11, Chaparrel, NM 88021 | 2010-08-30 |
| 1780783134 | William Beaumont Army Medical | Military/U.S. Coast Guard Pharmacy | Aberdeen Ave, Bldg 1363, White Sand Missile Range, NM 88002 | 2006-09-22 |
| 1962501312 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | Gibson Blvd Bldg 20167, Albuquerque, NM 87108 | 2006-09-22 |
| 1356755185 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St Bldg 15, Holloman Afb, NM 88330-8273 | 2014-06-19 |
| 1740694553 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 1501 San Pedro Dr Se Bldg 47, Albuquerque, NM 87108-5153 | 2014-06-19 |
| 1073610820 | 377th Medical Group | Military/U.S. Coast Guard Pharmacy | 2050a 2nd St Se, Kirtland Afb, NM 87117-5524 | 2006-09-20 |
| 1982701736 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Holloman Afb, NM 88330-8273 | 2006-09-20 |
| 1952374910 | 49th Medical Group | Military/U.S. Coast Guard Pharmacy | 280 1st St, Sgsr, Holloman Afb, NM 88330-8273 | 2006-02-09 |
| City | CANNON AFB |
| Zip Code | 88103 |
Please comment or provide details below to improve the information on 27TH 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.