17TH Medical Group

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

17TH MEDICAL GROUP

Practice address

271 Fort Richardson Ave
Goodfellow Afb, TX 76908-4901

Phone

(325) 654-5238

NPI assigned

Jun 4, 2012

Organization subpart

No

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

Authorized official

Name

James Forrest

Title

Colonel

Phone

(325) 654-3075

Specialties & licenses 1

Addresses

Tax ID family

17TH Medgrp-Goodfellow3 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.

• 17TH Medgrp-Goodfellow

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Goodfellow Afb, TX
  • NPI 1104805142
  NPD tax ID
• 17TH Medgrp-Goodfellow

  • Military/U.S. Coast Guard Pharmacy
  • Goodfellow Afb, TX
  • NPI 1346654175
  NPD tax ID

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338768000000",
    "number": "1235490574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 GREGORY DR",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769054213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 FORT RICHARDSON AVE",
            "city": "GOODFELLOW AFB",
            "state": "TX",
            "postal_code": "769084901",
            "telephone_number": "325-654-5238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "17TH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A",
        "authorized_official_last_name": "FORREST",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "COLONEL",
        "authorized_official_telephone_number": "325-654-3075"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 17TH Medgrp-Goodfellow
• 17TH Medgrp-Goodfellow
• Shakesha S Anderson Clarke
• Jordan C Armes, MD
• Ethan Scott Bannar, PSYD
• Matthew Thomas Bean
• Dale Andrew Beran, MD

• Health Service Clinic/Center in Goodfellow Afb, TX
• Providers in Goodfellow Afb, TX by specialty
• Health Service Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; 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.