NPIMap

Organization Active NPI

62D Medical Group Usaf

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • McChord AFB, WA
National Provider Identifier
1043270549
Registry record updated Nov 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
62D MEDICAL GROUP USAF
Practice address
690 A St
McChord AFB, WA 98438-1303
Phone
(253) 982-5586
Fax
(253) 982-5978
NPI assigned
Mar 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2010

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

Authorized official

Name
Serena Lynn Hansken
Title
Air Force Uniform Business Office
Phone
(703) 588-6419

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center 261QM1101X
Military/U.S. Coast Guard Pharmacy 332000000X

Addresses

Primary practice location

690 A St
McChord AFB, WA 98438-1303

Mailing address

690 A St
McChord AFB, WA 98438-1303
Phone (253) 982-5586

Other identifiers 1

IdentifierTypeStateIssuer
49-27197OtherWANCPDP

National Provider Directory

National Provider Directory
Tax ID family
62 Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1043270549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 A ST",
            "city": "MCCHORD AFB",
            "state": "WA",
            "postal_code": "984381303",
            "telephone_number": "253-982-5586",
            "fax_number": "253-982-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 A ST",
            "city": "MCCHORD AFB",
            "state": "WA",
            "postal_code": "984381303",
            "telephone_number": "253-982-5586",
            "fax_number": "253-982-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "62D MEDICAL GROUP USAF",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "HANSKEN",
        "authorized_official_first_name": "SERENA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "AIR FORCE UNIFORM BUSINESS OFFICE",
        "authorized_official_telephone_number": "703-588-6419"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "49-27197",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McChord AFB, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.