NPI age
11 years
Enumerated 2014-07-07
● Active Type 2 · Organization
Subpart
366th Medgrp-Mountain Home
366th Medgrp-Mountain Home is 1 of 3 military/u.s. coast guard pharmacy organizations in Idaho.
Primary specialty
Military/U.S. Coast Guard Pharmacy
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Morales
Chief Dha Pass
Last NPPES update
2025-06-13
Source: monthly bulk 2026-05
How this organization compares
Across 3 active military/u.s. coast guard pharmacy providers in Idaho.
NPI age
11 years
↓ 8 yr below median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 66% of peers with subspecialties
NPI lifetime · 2014 → 2026
2014-07Enumerated in NPPES
2014
2026
Where they practice
Primary practice location
90 Hope Dr Bldg 6000
Mountain Home Afb, ID 836481062
Mailing address
366 Medical Group Sgsbf, 90 Hope Dr. Bldg. 6000
Mtn Home Afb, ID 836481062
Authorized official
Hector Morales
Chief Dha Pass
📞 2105366650
Individual providers at this organization
20 individual providers on file at this primary practice address.
- Andrew Alton Family Medicine NPI 1285174185
- Nathan Anderson, O.D. Optometrist NPI 1285610444
- Becky Bautch, AGACNP-BC Nurse Practitioner NPI 1225432842
- Michael Bocek, PHARMD Pharmacist NPI 1124420799
- Paul Bodes, PHARMD Pharmacist NPI 1710229687
- Shannon Brantley, PHARMD Pharmacist NPI 1609973916
- Matthew Brown, M.D. Family Medicine NPI 1578825501
- Gloria Calvillo Physician Assistant NPI 1821629288
- Shelley Carter Military Health Care Provider NPI 1649530924
- Kyle Christensen, D.M.D. Dentist NPI 1730582438
- Thomas Christy, D.D.S Dentist NPI 1477833267
- Charlie Collenborne, M.D. Family Medicine NPI 1598945073
- Noah Comstock Military Health Care Provider NPI 1780566752
- Le Ann Egan Psychologist NPI 1457908360
- David Emert Dental Assistant NPI 1982259875
- Teagan Ferguson, DPT Physical Therapist NPI 1689101123
- Craig Folsom, D.D.S. Dentist NPI 1023007846
- Dakota Freve, M.D. Family Medicine NPI 1811345374
- Heather Funk, MS, RDN, LDN Dietitian, Registered NPI 1346665189
- Branyan Garcia, FNP Nurse Practitioner NPI 1063070241
Specialties
-
Military/U.S. Coast Guard Pharmacy PrimaryA 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...
-
PharmacyA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | 2146667 | PK |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
DoD MT HOME ePhcy
Practice context
Multi-provider organization. 20 individual providers on file at this primary address.
Subpart of 366th Medgrp-Mountain Home.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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