NPIMap

Organization Active NPI

21St Medical Group

Doing business as Peterson Pharmacy

  • Military/U.S. Coast Guard Pharmacy
  • Peterson AFB, CO
National Provider Identifier
1548369259
Registry record updated Jan 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
21ST MEDICAL GROUP
Doing business as
Peterson Pharmacy
Practice address
559 Vincent St
Peterson AFB, CO 80914-1541
Phone
(719) 333-2273
Fax
(719) 556-1106
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 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

559 Vincent St
Peterson AFB, CO 80914-1541

Mailing address

559 Vincent St
Peterson AFB, CO 80914-1541
Phone (719) 333-2273

Other identifiers 1

IdentifierTypeStateIssuer
2003352OtherPK

Other names 1

  • PETERSON PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
21 Medical Group6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

559 Vincent St
Peterson AFB, CO 80914
Phone (719) 556-1060

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452643200000",
    "number": "1548369259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-333-2273",
            "fax_number": "719-556-1106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-333-2273",
            "fax_number": "719-556-1106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "21ST MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2016-01-13",
        "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": "2003352",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PETERSON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peterson AFB, CO

Sources for this page

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