NPIMap

Organization Active NPI

366TH Medical Group SGSL

  • Military/U.S. Coast Guard Pharmacy
  • Mountain Home Afb, ID
National Provider Identifier
1811094667
Registry record updated Feb 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
366TH MEDICAL GROUP SGSL
Doing business as
MT HOME OP PHCY
Practice address
90 Hope Dr
BLDG 6000
Mountain Home Afb, ID 83648-1057
Phone
(208) 828-7480
Fax
(208) 828-3785
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 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

90 Hope Dr
BLDG 6000
Mountain Home Afb, ID 83648-1057

Mailing address

90 Hope Dr
BLDG 6000
Mountain Home Afb, ID 83648-1057
Phone (208) 828-7480

Other identifiers 1

IdentifierTypeStateIssuer
2021727OtherPK

Other names 1

  • MT HOME OP PHCY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
366TH Medical Group SGSL2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454889600000",
    "number": "1811094667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "address_2": "BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481057",
            "telephone_number": "208-828-7480",
            "fax_number": "208-828-3785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 HOPE DR",
            "address_2": "BLDG 6000",
            "city": "MOUNTAIN HOME AFB",
            "state": "ID",
            "postal_code": "836481057",
            "telephone_number": "208-828-7480",
            "fax_number": "208-828-3785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "366TH MEDICAL GROUP SGSL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-02-08",
        "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": "2021727",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MT HOME OP PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain Home Afb, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.