55TH Medical Group SGSL

Primary specialty

Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X

Legal business name

55TH MEDICAL GROUP SGSL

Doing business as

OFFUTT SATL PHCY

Practice address

BLDG 107 RM 101
Offutt, NE 68113

Phone

(402) 294-3221

Fax

(402) 294-3228

NPI assigned

Sep 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hector Morales

Title

Chief Dha Pass

Phone

(210) 536-6650

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• OFFUTT SATL PHCY Doing business as

Tax ID family

55TH Medical Group SGSL2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 55TH Medical Group SGSL

  • Military/U.S. Coast Guard Pharmacy
  • Bellevue, NE
  • NPI 1194824524
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454889600000",
    "number": "1003915430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLDG 107 RM 101",
            "city": "OFFUTT",
            "state": "NE",
            "postal_code": "68113",
            "telephone_number": "402-294-3221",
            "fax_number": "402-294-3228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 107 RM 101",
            "city": "OFFUTT",
            "state": "NE",
            "postal_code": "68113",
            "telephone_number": "402-294-3221",
            "fax_number": "402-294-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "55TH MEDICAL GROUP SGSL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2016-02-08",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "CHIEF DHA PASS",
        "authorized_official_telephone_number": "210-536-6650"
    },
    "taxonomies": [
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2055513",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OFFUTT SATL PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bridget Larson, PH.D.

• Military/U.S. Coast Guard Pharmacy in Offutt, NE
• Providers in Offutt, NE by specialty
• Military/U.S. Coast Guard Pharmacy in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.