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Organization

366th Medgrp-Mountain Home

NPI Record: ActiveClinic/Center — Military and U.S. Coast Guard Ambulatory Procedure
NPI1063487791
Mountain Home Afb, Idaho

Provider's NPPES record last updated: June 17, 2025

Overview

Entity Type
Organization
NPI
1063487791
Primary Specialty
Clinic/Center — Military and U.S. Coast Guard Ambulatory Procedure
Practice Location
Mountain Home Afb, Idaho
Organization Subpart
Yes
Parent Organization
366th Medgrp-Mountain Home

Federal Screening

NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.

List of Excluded Individuals/Entities (LEIE)

HHS Office of Inspector General

No potential match identified

No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.

Source data
September 10, 2026
Records indexed
84,001
Screened
Sep 17, 2026, 10:45 PM UTC

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

SAM.gov Exclusions

U.S. General Services Administration

Not checked

SAM.gov Exclusions was not checked.

SAM.gov screening is not configured on this deployment. No SAM check has been performed.

Screened
Not checked

This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

Run a name-based screening

Searches OIG LEIE and SAM.gov by name and reviews every potential match.

Specialties & Taxonomies

  • Clinic/Center

    Military and U.S. Coast Guard Ambulatory Procedure

    Ambulatory Health Care Facilities

    Primary

    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.

    Taxonomy code 261QM1101X
  • Clinic/Center

    Military/U.S. Coast Guard Outpatient

    Ambulatory Health Care Facilities

    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.

    Taxonomy code 261QM1100X
  • Military/U.S. Coast Guard Pharmacy

    Suppliers

    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.

    Taxonomy code 332000000X

Practice Locations

Practice Location

90 Hope Drive Bldg 6000

366 Medical Group

Mountain Home Afb, Idaho 83648-1062

Phone: (208) 828-7470

Record Information

Enumeration Date
February 17, 2006
Provider's NPPES Record Last Updated
June 17, 2025
Certification Date
June 17, 2025
NPISignal NPPES Dataset
August 2026

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