62ND Med GRP

Primary specialty

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

Legal business name

62ND MED GRP

Doing business as

McChord Main Phcy

Practice address

690 Barnes Blvd
McChord AFB, WA 98438-1303

Phone

(253) 982-2474

Fax

(253) 982-8401

NPI assigned

Sep 22, 2006

Last updated

Sep 1, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

62ND MED GRPAs 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

MGR Phrmcy Operations CNTR

Phone

(210) 221-8443

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MCCHORD MAIN PHCY Doing business as

Tax ID family

62ND Med GRP3 organizations share this tax ID, including this one

Part of

62ND Med GRP

Other organizations with this tax ID 2

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

• 62 Medical Group

  • Primary Care Clinic/Center
  • McChord AFB, WA
  • NPI 1801837398
  NPD tax ID
• 62D Medical Group Usaf

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • McChord AFB, WA
  • NPI 1043270549
  NPD tax ID

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251763200000",
    "number": "1366541401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 BARNES BLVD",
            "city": "MCCHORD AFB",
            "state": "WA",
            "postal_code": "984381303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 BARNES BLVD",
            "city": "MCCHORD AFB",
            "state": "WA",
            "postal_code": "984381303",
            "telephone_number": "253-982-2474",
            "fax_number": "253-982-8401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "62ND MED GRP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "62ND MED GRP",
        "enumeration_date": "2006-09-22",
        "last_updated": "2009-09-01",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "MGR PHRMCY OPERATIONS CNTR",
        "authorized_official_telephone_number": "210-221-8443"
    },
    "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": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4927197",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCCHORD MAIN PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 62 Medical Group
• 62D Medical Group Usaf
• Air Force
• Evelyn Yvonne Anderson
• John R Andrus, M.D., MPH
• James Christopher Ault, RN
• Erick H Auyoung, O.D.

• Military/U.S. Coast Guard Pharmacy in McChord AFB, WA
• Providers in McChord AFB, WA by specialty
• Military/U.S. Coast Guard Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2009; 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.