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NPI Code Detail

MEDICARE: 99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL

MEDICARE: 99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1100XMilitary/U.S. Coast Guard Outpatient Clinic/Center
2261QM1101XMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
3332000000XMilitary/U.S. Coast Guard Pharmacy
4286500000XMilitary Hospital

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12975742OTHERNVNCPDP

General Provider Information

NPI Number : 1154393759
Entity Type Code : Organization
Provider Name (Legal Business Name) : 99TH MEDICAL GROUP - MIKE O'CALLAGHAN FEDERAL HOSPITAL
Provider Business Mailing Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Authorized Official
Title or Position : DHA UBO
Name : JEN LEWANDOWSKI
Credential :
Telephone Number : 703-817-4030
Provider Enumeration Date : 02/07/2006
Last Update Date : 06/24/2025

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