366TH Medgrp-Mountain Home

Primary specialty

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

Legal business name

366TH MEDGRP-MOUNTAIN HOME

Doing business as

DoD MT HOME ePhcy

Practice address

90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062

Phone

(208) 828-7521

Fax

(208) 828-7676

NPI assigned

Jul 7, 2014

Organization subpart

Yes

Parent organization

366TH MEDGRP-MOUNTAIN HOMEAs reported in NPPES

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

• DoD MT HOME ePhcy Doing business as

Tax ID family

366TH Medgrp-Mountain Home2 organizations share this tax ID, including this one

Part of

366TH Medgrp-Mountain Home

Other organizations with this tax ID 1

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

• 366TH Medgrp-Mountain Home

  • Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
  • Mountain Home Afb, ID
  • NPI 1063487791
  NPD tax ID

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1144636515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 MEDICAL GROUP SGSBF",
            "address_2": "90 HOPE DR. BLDG. 6000",
            "city": "MTN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "208-828-7521",
            "fax_number": "208-828-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481062",
            "telephone_number": "208-828-7521",
            "fax_number": "208-828-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "366TH MEDGRP-MOUNTAIN HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "366TH MEDGRP-MOUNTAIN HOME",
        "enumeration_date": "2014-07-07",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "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": "2146667",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DoD MT HOME ePhcy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 366TH Medgrp-Mountain Home
• 366TH Medical Group SGSL
• Andrew Alton
• Nathan Lee Anderson, O.D.
• Ronald Wesley Bailey, M.D.
• Becky M Bautch, AGACNP-BC

• Military/U.S. Coast Guard Pharmacy in Mountain Home Afb, ID
• Providers in Mountain Home Afb, ID by specialty
• Military/U.S. Coast Guard Pharmacy in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; 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.