354TH MEDICAL GROUP (NPI# 1902867229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902867229 |
| Entity Type | Organization |
| Organization Name | 354TH MEDICAL GROUP |
| Other Organization Name | EIELSON AFB MTF |
| Practice Address |
2630 Central Ave Suite 1m07 Eielson Afb AK 99702-2325 |
| Practice Telephone | 9073776579 |
| Mailing Telephone | 9073776579 |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2014-03-07 |
| Authorized Official Name | THERESA MARIE MITCHELL (AIR FORCE UBO ANALYST) |
| Authorized Official Telephone | 7036817613 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers | ||
| N | 261QM1101X |
Clinic/Center Specialization: Military and U.S. Coast Guard Ambulatory Procedure |
Ambulatory Health Care Facilities | ||
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | NCPDP | 02-02399 | 01 |
| Other Name | Type Code |
|---|---|
| Eielson AFB MTF | Other Name - Individual/Organization |
| Street Address |
2630 CENTRAL AVE SUITE 1M07 |
| City | EIELSON AFB |
| State | AK |
| Zip Code | 99702-2325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578545109 | Robert Greg Patterson | Family Medicine | 2630 Central Ave, Suite 1m07, Eielson Afb, AK 99702-2325 | 2005-11-18 |
| 1689274664 | Bradley Martin | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1891395802 | Kaleb Hatfield | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1346840329 | Stephanie Danielle Rowe | Dental Assistant | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1851991855 | Cody Scott Lemon | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1578189387 | Eric Dylan Mason | Military Health Care Provider | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-06-18 |
| 1912546524 | Susan Liebig | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2019-12-30 |
| 1639724636 | Sandra Muniz | Licensed Practical Nurse | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2019-08-06 |
| 1104393446 | Matthew Gray | Military Health Care Provider | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2018-10-24 |
| 1952885121 | Anthony Ewell-kollmann | Dentist | 2630 Central Ave, Eielson Afb, AK 99702 | 2018-09-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174864904 | Eric Noll | Optometrist | 2630 Central Ave # 3349, Eielson Afb, AK 99702 | 2013-03-04 |
| 1407125123 | Optical Center | Technician/Technologist | 451 Broadway Street, Eielson Afb Aafes Exchange, Eielson, AK 99702 | 2011-12-27 |
| 1063649234 | John Michael Strothenke | Military Health Care Provider | 2630 Central Avenue Suite 1, 354 Medical Operations Squadron, Clinical Medicine Flt, Eielson Air Force Base, AK 99702 | 2009-06-16 |
| 1225272073 | Landru Derek Medvec | Military Health Care Provider | 2422 Arctic Ave, Apt D, Eielson Afb, AK 99702 | 2009-04-23 |
| 1780875617 | Victoria L Ketchum | Specialist | E. Cowles, Fairbanks Memorial Hospital, Fairbanks, AK 99702 | 2007-08-06 |
| 1689768103 | Angie M. Walker | Social Worker | 2630 Central Av, Suite 1m07, Eielson Afb, AK 99702 | 2006-10-02 |
| 1306945464 | 354th Medical Group Mdg | Military/U.S. Coast Guard Pharmacy | Bldg 3349 Central Ave, Eielson Afb, AK 99702 | 2006-09-22 |
| 1760442297 | Susan Mary Runyan | Dietitian, Registered | 354th Medical Group, 2630 Central Ave, Suite 1m07, Eielson Afb, AK 99702 | 2006-03-27 |
| 1972166916 | Andrew Joseph Colburn | Registered Nurse | 2630 Central Ave # 3349, Eielson Afb, AK 99702 | 2019-04-16 |
| 1306375704 | Robert Marshall Walter | Dentist | 2630 Central Ave Bldg 3349, Eielson Afb, AK 99702 | 2017-06-08 |
| Find all providers in zip 99702 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033517206 | United States Coast Guard | Clinic/Center | Base Kodiak Building N-46, Kodiak, AK 99619 | 2014-12-19 |
| 1679721864 | Bassett Army Community Hospital | Clinic/Center | 4066 Spruce St, Ft Wainwright, AK 99703-7400 | 2008-09-03 |
| 1295983591 | Bassett Army Community Hospital | Clinic/Center | 661 Arctic Road, Ft. Greely, AK 99731 | 2008-08-29 |
| 1871796615 | Bassett Army Community Hospital | Clinic/Center | 1060 Gaffney Rd Stop 7500, Mcds-dd-hos, Fort Wainwright, AK 99703-5002 | 2007-06-08 |
| 1831392679 | Bassett Army Community Hospital | Clinic/Center | 724 Postal Service Loop Stop 7500, Mcds-dd-r, Fort Richardson, AK 99505-7500 | 2007-06-08 |
| 1699877993 | Bassett Army Community Hospital | Clinic/Center | 1060 Gaffney Rd # 7420, Ft Wainwright, AK 99703-7420 | 2006-09-05 |
| 1346211059 | U. S. Coast Guard | Clinic/Center | 611 Airport Dr, Sitka, AK 99835-9436 | 2006-01-30 |
| 1427206630 | Bassett Army Community Hospital | Clinic/Center | 3406 Alder Ave, Ft Wainwright, AK 99703 | 2008-08-29 |
| 1730383886 | Bassett Army Community Hospital | Clinic/Center | 3406 Alder Ave, Mcds-dd-tdc, Ft Wainwright, AK 99703-5002 | 2007-06-13 |
| 1164635728 | Bassett Army Community Hospital | Clinic/Center | 724 Postal Service Loop Stop 7499, Fort Richardson, AK 99505-7499 | 2007-05-08 |
| Find all providers with the same taxonomy | ||||
| City | EIELSON AFB |
| Zip Code | 99702 |
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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.