4TH MEDICAL GROUP (NPI# 1972602258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972602258 |
| Entity Type | Organization |
| Organization Name | 4TH MEDICAL GROUP |
| Other Organization Name | SEYJOHN PHCY 4TH MDG |
| Practice Address |
1050 Jabara Ave Seymour Johnson Afb Seymour Johnson A F B NC 27531-2310 |
| Practice Telephone | 9197221814 |
| Practice Fax Number | 9197221820 |
| Mailing Telephone | 9197221814 |
| Mailing Fax Number | 9197221820 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2016-01-15 |
| 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 | 2070465 | 01 |
| Other Name | Type Code |
|---|---|
| SEYJOHN PHCY 4TH MDG | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811305477 | 4th Medical Group | Military/U.S. Coast Guard Pharmacy | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531-2310 | 2014-07-28 |
| 1659470987 | 4th Medical Group | Military/U.S. Coast Guard Pharmacy | 1050 Jabara Ave, Bldg 3735 Edwards St, Sjafb, NC 27531-2310 | 2006-09-22 |
| Street Address |
1050 JABARA AVE SEYMOUR JOHNSON AFB |
| City | SEYMOUR JOHNSON A F B |
| State | NC |
| Zip Code | 27531-2310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902343858 | Isaiah Gary Allison | Military Health Care Provider | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531-2310 | 2017-01-30 |
| 1235676420 | Beth A Brustuen | Psychologist | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531-2310 | 2017-01-25 |
| 1679924344 | Austin Mcjunkins | Surgery | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531 | 2016-06-23 |
| 1346690666 | Kyla Marie Berrier Beasley | Nurse Practitioner | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531-2310 | 2016-06-17 |
| 1659737419 | Wilson Andrew Harris IIi | Dietitian, Registered | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531-2310 | 2016-01-11 |
| 1811305477 | 4th Medical Group | Military/U.S. Coast Guard Pharmacy | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531-2310 | 2014-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376185348 | Adam Golos | Pharmacist | 2803 Medical, N Campus Dr, Goldsboro, NC 27531 | 2019-10-11 |
| 1346747011 | Rachel Eden Leigh Palmer | Military Health Care Provider | 2803 Medical Campus Dr, Seymour Johnson Afb, NC 27531 | 2018-04-10 |
| 1689108508 | Peri Fouss | Pediatrics | 2803 Medical Campus Drive, Goldsboro, NC 27531 | 2017-04-18 |
| 1700256427 | Karen Schaefer | Psychologist | 1050 Jabara Ave., Goldsboro, NC 27531 | 2015-10-07 |
| 1679059737 | Charles Billig | Physician Assistant | 2803 Medical Campus Dr, Goldsboro, NC 27531 | 2018-07-12 |
| 1710413216 | Michael Everett Ridlehoover | Dentist | 2803 Medical Campus Drive, Seymour Johnson Afb, NC 27531 | 2017-05-04 |
| 1831173558 | Thomas Koritz Clinic | Clinic/Center | 1050 Jabara Avenue, Seymour Johnson Afb, NC 27531-2310 | 2005-12-06 |
| 1053316562 | Stephen Brian Irvin | Family Medicine | 1050 Jabarrah Ave, Seymour Johnson A F B, NC 27531-2310 | 2005-06-21 |
| 1952704975 | Andrea Sumner | Physician Assistant | 1050 Jabarrah Ave, Seymour Johnson A F B, NC 27531-2310 | 2014-10-04 |
| 1114363884 | Nathan Lee Carlson | Military Health Care Provider | 1050 Jabarrah Ave, Goldsboro, NC 27531-2310 | 2013-05-21 |
| Find all providers in zip 27531 | ||||
| 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 |
|---|---|---|---|---|
| 1811305477 | 4th Medical Group | Military/U.S. Coast Guard Pharmacy | 1050 Jabara Ave, Seymour Johnson A F B, NC 27531-2310 | 2014-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356907471 | Womack Army Medical Center | Military/U.S. Coast Guard Pharmacy | 4-2817 Reilly Rd Bldg B, Fort Bragg, NC 28310-0001 | 2019-05-14 |
| 1932577368 | Womack Army Medical Center | Military/U.S. Coast Guard Pharmacy | 55 Centennial Pkwy, Cameron, NC 28326-4013 | 2015-09-02 |
| 1427435585 | Naval Medical Center Camp Lejeune | Military/U.S. Coast Guard Pharmacy | Stone St. Extention, Bldg Nh200, Camp Lejeune, NC 28547 | 2015-04-28 |
| 1104238724 | Naval Health Clinic Cherry Point | Military/U.S. Coast Guard Pharmacy | Naval Health Clinic Cherry Point, Building 4389, Beaufort Rd, Mcas Cherry Point, NC 28533-0023 | 2014-06-02 |
| 1821400516 | Naval Medical Center Camp Lejeune | Military/U.S. Coast Guard Pharmacy | Brewster Blvd Bldg Nh100, Usn-naval Hospital, Camp Lejeune, NC 28547-0100 | 2014-05-29 |
| 1710252499 | Naval Medical Center Camp Lejeune | Military/U.S. Coast Guard Pharmacy | A Street, Bldg # Rr 440, Camp Lejeune, NC 28542-0117 | 2012-03-14 |
| 1447359732 | Womack Army Medical Center | Military/U.S. Coast Guard Pharmacy | Lane Rd Bldg M4861, Fort Bragg, NC 28310-0001 | 2006-09-22 |
| 1538268826 | Womack Army Medical Center | Military/U.S. Coast Guard Pharmacy | Butner Rd Bldg 85050, Fort Bragg, NC 28310-0001 | 2006-09-22 |
| 1093814386 | Womack Army Medical Center | Military/U.S. Coast Guard Pharmacy | Gruber Rd Bldg C1722, Fort Bragg, NC 28310-0001 | 2006-09-22 |
| 1215036546 | Naval Health Clinic Cherry Point | Military/U.S. Coast Guard Pharmacy | Bldg 4389 Beaufort St, Cherry Point, NC 28533-0023 | 2006-09-22 |
| Find all providers with the same taxonomy | ||||
| City | SEYMOUR JOHNSON A F B |
| Zip Code | 27531 |
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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.