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17th Medical Group
Military/U.S. Coast Guard Pharmacy in Goodfellow Afb, Texas
NPI 1104805142

17th Medical Group is a Military/U.S. Coast Guard Pharmacy based in Goodfellow Afb, TX. 17th Medical Group practices in Goodfellow Afb, TX. The NPI Number for 17th Medical Group is 1104805142 and holds a License No. (Texas).

The current practice location address for 17th Medical Group is 271 Fort Richardson Ave, Goodfellow Afb, TX and can be reached out via phone at 325-654-5974 and via fax at 325-654-3121.

Location: 271 Fort Richardson Ave, Goodfellow Afb, TX, 76908-4901
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1104805142
Provider Name
17th Medical Group
Credential
Provider Entity Type
Organization
Address
271 Fort Richardson Ave, Goodfellow Afb, TX, 76908-4901
Phone Number
325-654-5974
Fax Number
325-654-3121
Provider Enumeration Date
01/10/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4596740 01 TX NCPDP
institution
Provider Business Practice Location Address Details
Address
271 Fort Richardson Ave
City
Goodfellow Afb
State
Texas
Zip
76908-4901
Phone Number
325-654-5974
Fax Number
325-654-3121
person
Provider Business Mailing Address Details
Address
271 Fort Richardson Ave
City
Goodfellow Afb
State
Texas
Zip
76908-4901
Phone Number
325-654-5974
Fax Number
325-654-3121
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Military/U.S. Coast Guard Outpatient
Taxonomy
261QM1100X
License No.
()
Definition
The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Military and U.S. Coast Guard Ambulatory Procedure
Taxonomy
261QM1101X
License No.
()
Definition
That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmaceuticals.
person
Provider's Taxonomy Details 3
Type
Suppliers
Classification
Military/U.S. Coast Guard Pharmacy
Speciality
-
Taxonomy
332000000X
License No.
(Texas)
Definition
A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services.
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