NPIMap

Organization Active NPI

42ND Medical Group SGSL

  • Military/U.S. Coast Guard Pharmacy
  • Maxwell Afb, AL
National Provider Identifier
1255430302
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
42ND MEDICAL GROUP SGSL
Doing business as
MAXWELL MAIN PHCY42ND MDG
Practice address
330 S Twining St BLDG 760
Maxwell Afb, AL 36112
Phone
(334) 953-6868
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Pharmacy 332000000X Primary
Pharmacy 333600000X

Addresses

Primary practice location

330 S Twining St BLDG 760
Maxwell Afb, AL 36112

Mailing address

330 S Twining St BLDG 760
Maxwell Afb, AL 36112
Phone (334) 953-6868

Other identifiers 1

IdentifierTypeStateIssuer
1993811OtherPK

Other names 1

  • MAXWELL MAIN PHCY42ND MDG Doing business as

National Provider Directory

National Provider Directory
Tax ID family
42D Medgrp-Maxwell4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

330 S Twining St BLDG 760
Maxwell Afb, AL 36112
Phone (334) 953-6868

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1255430302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 S TWINING ST BLDG 760",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "36112",
            "telephone_number": "334-953-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 S TWINING ST BLDG 760",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "36112",
            "telephone_number": "334-953-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "42ND MEDICAL GROUP SGSL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2016-10-05",
        "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": "1993811",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAXWELL MAIN PHCY42ND MDG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maxwell Afb, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.