Organization
366TH MEDGRP-MOUNTAIN HOME
Active
Parent organization
366TH MEDGRP-MOUNTAIN HOME
Other names
DoD MT HOME ePhcy
Organization subpart
Yes
Provider details
NPI number
Legal business name
366TH MEDGRP-MOUNTAIN HOME
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7521
(208) 828-7676
Mailing address
366 MEDICAL GROUP SGSBF, 90 HOPE DR. BLDG. 6000, MTN HOME AFB, ID 83648-1062
(208) 828-7521
(208) 828-7676
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146667
PK
—
Enumeration date
07/07/2014
Last updated
06/13/2025
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