316TH Medgrp-Malcolm Grow

Primary specialty

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

Legal business name

316TH MEDGRP-MALCOLM GROW

Doing business as

DoD BOLLING ePhcy

Practice address

238 Brookley Ave SW
579TH Medical Group
Bolling AFB, DC 20032-7704

Phone

(202) 404-7742

Fax

(202) 404-1216

NPI assigned

May 29, 2014

Last updated

Mar 12, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

316TH MEDGRP-MALCOLM GROWAs reported in NPPES

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

Authorized official

Name

William Michael Condon

Title

Dha Financial Manager

Phone

(240) 401-3643

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DoD BOLLING ePhcy Doing business as

Tax ID family

316TH Medgrp-Malcolm Grow3 organizations share this tax ID, including this one

Part of

316TH Medgrp-Malcolm Grow

Other organizations with this tax ID 2

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

• 316TH Medgrp-Malcolm Grow

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Washington, DC
  • NPI 1013988328
  NPD tax ID
• X Awaiting Inactivation3

  • Military Hospital
  • Fort Rucker, AL
  • NPI 1174774863
  NPD tax ID

Locations

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741737600000",
    "number": "1861804551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 W PERIMETER RD",
            "city": "JB ANDREWS",
            "state": "MD",
            "postal_code": "207626602",
            "telephone_number": "202-404-7742",
            "fax_number": "202-404-1216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 BROOKLEY AVE SW",
            "address_2": "579TH MEDICAL GROUP",
            "city": "BOLLING AFB",
            "state": "DC",
            "postal_code": "200327704",
            "telephone_number": "202-404-7742",
            "fax_number": "202-404-1216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "316TH MEDGRP-MALCOLM GROW",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "316TH MEDGRP-MALCOLM GROW",
        "enumeration_date": "2014-05-29",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DHA FINANCIAL MANAGER",
        "authorized_official_telephone_number": "240-401-3643"
    },
    "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": "2145981",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DoD BOLLING ePhcy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James R Abbott, M.D.
• Robin Christina Abbott, PHYSICIAN ASSISTANT
• Michael James Anderson, IDMT
• Edwardson A Aquino
• Anika C Beavers, MSW, LCSW

• Military/U.S. Coast Guard Pharmacy in Bolling AFB, DC
• Providers in Bolling AFB, DC by specialty
• Military/U.S. Coast Guard Pharmacy in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.