LITTLE ROCK AFB MTF (19TH MDSS SGSR) NPI 1073591830

Clinic/Center (Military/U.S. Coast Guard Outpatient) in Lr Afb, AR

NPI 1073591830 Organization Clinic/Center Military/U.S. Coast Guard Outpatient

About LITTLE ROCK AFB MTF (19TH MDSS SGSR)

Little Rock Afb Mtf (19th Mdss Sgsr) is a provider established in Lr Afb, Arkansas specializing in clinic/center (military/u.s. coast guard outpatient) . The NPI number of Little Rock Afb Mtf (19th Mdss Sgsr) is 1073591830 and was assigned on January 2006. The practitioner's primary taxonomy code is 261QM1100X. The provider is registered as an organization and their NPI record was last updated 8 years ago. The provider's other name is Little Rock Afb Mtf. The authorized official of this NPI record is Theresa Marie Mitchell (Air Force Ubo Analyst)

NPI

1073591830

Provider NameLITTLE ROCK AFB MTF (19TH MDSS SGSR)
Provider Location Address1090 ARNOLD DR LR AFB, AR 72099
Provider Mailing Address1090 ARNOLD DR LR AFB, AR 72099
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameLITTLE ROCK AFB MTF
Other Name TypeOther Name (5)
Enumeration Date01-03-2006
Last Update Date02-18-2014


Primary Taxonomy

Taxonomy Code261QM1100X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationMilitary/U.S. Coast Guard Outpatient
Taxonomy DescriptionThe 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.

Business Address

LITTLE ROCK AFB MTF
1090 ARNOLD DR
LR AFB, AR
ZIP 72099
Phone: (501) 987-7414
Fax: (501) 987-7310

Get Directions


Mailing Address

LITTLE ROCK AFB MTF
1090 ARNOLD DR
LR AFB, AR
ZIP 72099
Phone: (501) 987-7414
Fax: (501) 987-7310



Authorized Official

Authorized Official Name THERESA MARIE MITCHELL
Authorized Official TitleAIR FORCE UBO ANALYST
Authorized Official Phone(703) 681-7613

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory ProcedureNo

Taxonomy Description: 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.

2332000000XSuppliersMilitary/U.S. Coast Guard PharmacyNo

Taxonomy Description: 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.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
420846OTHER (01)AR

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1386638401MR. JAMES PETER VAKOS PT
Individual
Physical Therapist (Orthopedic)1090 ARNOLD DR 314 MDOS/SGOKY
LITTLE ROCK AFB, AR 72099
(501) 987-7466
1740275536MS. MARYBETH S. LENZ NP
Individual
Nurse Practitioner (Women's Health)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-7234
1346223237DR. VALERIE J CLEGG MD
Individual
Pediatrics1090 ARNOLD DR 314TH MEDICAL GROUP
LITTLE ROCK AFB, AR 72099
(501) 987-8911
1134103427DR. CHARLES MANIS FRIEDMAN MD
Individual
Radiology (Diagnostic Radiology)1090 ARNOLD DR
LITTLE ROCK AIR FORCE BASE, AR 72099
(501) 987-7481
1255392619 SUSANNE HAVEL CPNP
Individual
Nurse Practitioner (Pediatrics)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-7245
1881626950DR. JERRI LEE FLETCHER P.D.
Individual
Pharmacist1090 ARNOLD DR
LITTLE ROCK AIR FORCE BASE, AR 72099
(501) 987-7446
1255439055DR. MATTHEW JOE EDWARDS D.M.D
Individual
Dentist (General Practice)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-7304
1154480622DR. AMANDA GAIL BELLAMY PHARM D
Individual
Pharmacist1090 ARNOLD DR
JACKSONVILLE, AR 72099
(501) 987-8981
1912038753MS. KATHERINE B GILCHRIST LCSW
Individual
Social Worker (Clinical)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-7338
1447400668 SUMMER WILLIAMSON
Individual
Optometrist1090 ARNOLD DR
LITTLE ROCK AIR FORCE BASE, AR 72099
(501) 987-8702
1487888574 TOMMY NELSON BELCHER IDMT
Individual
Military Health Care Provider (Independent Duty Medical Technicians)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-1458
1770718017MR. CHRISTOPHER JOHN HOAR IDMT
Individual
Military Health Care Provider (Independent Duty Medical Technicians)1090 ARNOLD DR BLDG 1090/FLIGHT MEDICINE
LR AFB, AR 72099
(501) 987-7319
1396079570DR. ROCKY CHRISTOPHER LIESMAN PSY.D
Individual
Psychologist (Clinical)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-6249
1982913257 JESSIKA TWIN TAYLOR RDH
Individual
Dental Hygienist1090 ARNOLD DR
LITTLE ROCK AIR FORCE BASE, AR 72099
(501) 987-7304
1427351030 TIFFANI MCKEE
Individual
Military Health Care Provider (Independent Duty Medical Technicians)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-7319
1013282086MRS. TANYA NASHEL MILLER ADC
Individual
Counselor (Addiction (Substance Use Disorder))1090 ARNOLD DR
JACKSONVILLE, AR 72099
(501) 987-7338
1457301582DR. LINDY W WINTER MD
Individual
Pediatrics (Neonatal-Perinatal Medicine)1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-7408
1932536687DR. AMANDA KILLINGER DO
Individual
General Practice1090 ARNOLD DR FLIGHT MEDICINE CLINIC
LITTLE ROCK AFB, AR 72099
(501) 987-7311
1902890791DR. AARON JOSEPH IRVIN I DDS
Individual
Dentist (General Practice)1090 ARNOLD DR LITTLE ROCK AFB
JACKSONVILLE, AR 72099
(501) 987-7337
193220897219TH MDSS SGSR
Organization
Military/U.S. Coast Guard Pharmacy1090 ARNOLD DR
LITTLE ROCK AFB, AR 72099
(501) 987-8981

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.