17TH Medgrp-Goodfellow

Primary specialty

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

Legal business name

17TH MEDGRP-GOODFELLOW

Doing business as

DoD GOODFELLOW ePhcy

Practice address

271 Fort Richardson Ave
Goodfellow Afb, TX 76908-4901

Phone

(325) 654-3101

Fax

(325) 654-5898

NPI assigned

Jun 19, 2014

Organization subpart

Yes

Parent organization

17TH MEDGRP-GOODFELLOWAs 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 1

Addresses

Other identifiers 1

Other names 1

• DoD GOODFELLOW ePhcy Doing business as

Tax ID family

17TH Medgrp-Goodfellow3 organizations share this tax ID, including this one

Part of

17TH Medgrp-Goodfellow

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 Medical Group

  • Health Service Clinic/Center
  • Goodfellow Afb, TX
  • NPI 1235490574
  NPD tax ID

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1346654175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 MEDICAL GROUP",
            "address_2": "271 FORT RICHARDSON AVE.",
            "city": "GOODFELLOW AFB",
            "state": "TX",
            "postal_code": "76908",
            "telephone_number": "325-654-3101",
            "fax_number": "325-654-5898"
        },
        {
            "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": "325-654-3101",
            "fax_number": "325-654-5898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "17TH MEDGRP-GOODFELLOW",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "17TH MEDGRP-GOODFELLOW",
        "enumeration_date": "2014-06-19",
        "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
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146403",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DoD GOODFELLOW ePhcy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• Military/U.S. Coast Guard Pharmacy in Goodfellow Afb, TX
• Providers in Goodfellow Afb, TX by specialty
• Military/U.S. Coast Guard Pharmacy in Texas

• 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.