Organization · Type 2 NPI
366th Medgrp-Mountain Home
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center · Mountain Home Afb, ID
Practice location
90 Hope Drive Bldg 6000, 366 Medical Group
Mountain Home Afb, ID 83648-1062
Fax (208) 828-2753
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Military/U.S. Coast Guard Outpatient Clinic/Center | 261QM1100X | None listed |
| Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center Primary | 261QM1101X | None listed |
| Military/U.S. Coast Guard Pharmacy | 332000000X | None listed |
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center: 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" pharmace…
2 other providers at this address
About NPI 1063487791
366th Medgrp-Mountain Home's National Provider Identifier is 1063487791, issued on Feb 17, 2006. The primary taxonomy on file is Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center (261QM1101X), and the practice location is in Mountain Home Afb, ID. The record was last updated on Jun 17, 2025.