NPIMap

Organization Active NPI

21St Medgrp-Peterson

Doing business as DoD PETERSON SATL ePhcy

  • Military/U.S. Coast Guard Pharmacy
  • Peterson AFB, CO
National Provider Identifier
1932514171
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X
Legal business name
21ST MEDGRP-PETERSON
Doing business as
DoD PETERSON SATL ePhcy
Practice address
110 W ENT Ave
Peterson AFB, CO 80914-1595
Phone
(719) 556-0865
Fax
(719) 556-1106
NPI assigned
Jun 26, 2014
Organization subpart
Yes
Parent organization
21ST MEDGRP-PETERSONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

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

110 W ENT Ave
Peterson AFB, CO 80914-1595

Mailing address

21St Medical Group C/O Rmo Office
559 Vincent St
Peterson AFB, CO 80914-1541
Phone (719) 556-0865

Other identifiers 1

IdentifierTypeStateIssuer
2146545OtherPK

Other names 1

  • DoD PETERSON SATL ePhcy Doing business as

National Provider Directory

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

Other organizations with this tax ID 5

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

Locations

110 W Ent Ave
Peterson AFB, CO 80914
Phone (719) 556-0865

NPI Registry JSON

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1932514171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21ST MEDICAL GROUP C/O RMO OFFICE",
            "address_2": "559 VINCENT ST",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-556-0865",
            "fax_number": "719-556-1106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W ENT AVE",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141595",
            "telephone_number": "719-556-0865",
            "fax_number": "719-556-1106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "21ST MEDGRP-PETERSON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "21ST MEDGRP-PETERSON",
        "enumeration_date": "2014-06-26",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "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": "2146545",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DoD PETERSON SATL ePhcy",
            "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 Jun 13, 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.