375TH Medgrp-Scott

Primary specialty

Military HospitalTaxonomy code 286500000X

Legal business name

375TH MEDGRP-SCOTT

Practice address

310 W Losey St
Scott AFB, IL 62225-5250

Phone

(618) 256-6267

Fax

(618) 256-7931

NPI assigned

Dec 15, 2005

Last updated

May 29, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

375TH MEDGRP-SCOTTAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bruce Jay Gardner II, M.D.

Title

Resident Physician

Phone

(618) 256-6267

Specialties & licenses 1

Addresses

Tax ID family

375TH Medgrp-Scott3 organizations share this tax ID, including this one

Part of

375TH Medgrp-Scott

Other organizations with this tax ID 2

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

• 375TH Medgrp-Scott

  dba DoD SCOTT ePhcy

  • Military/U.S. Coast Guard Pharmacy
  • Scott AFB, IL
  • NPI 1790190940
  NPD tax ID
• 375TH Medgrp-Scott

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Scott AFB, IL
  • NPI 1851373161
  NPD tax ID

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1861478448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-6267",
            "fax_number": "618-256-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-6267",
            "fax_number": "618-256-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "375TH MEDGRP-SCOTT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "375TH MEDGRP-SCOTT",
        "enumeration_date": "2005-12-15",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "RESIDENT PHYSICIAN",
        "authorized_official_telephone_number": "618-256-6267",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "286500000X",
            "taxonomy_group": "",
            "desc": "Military Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 375TH Medgrp-Scott (DoD SCOTT ePhcy)
• 375TH Medgrp-Scott
• Hattie D Alexander, D.O.
• Nicole Andreoli, MT(ASCP)
• Kristine Eva Andrews, M.D.
• Diane Beckius Archbold, DDS
• Nikki L Beadle, O.D

• Military Hospital in Scott AFB, IL
• Providers in Scott AFB, IL by specialty
• Military Hospital in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.