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NPI Code Detail

MEDICARE: 90TH MEDGRP-FE WARREN

MEDICARE: 90TH MEDGRP-FE WARREN
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
1261QM1101XMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
2332000000XMilitary/U.S. Coast Guard Pharmacy
3261QM1100XMilitary/U.S. Coast Guard Outpatient Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152-03625OTHERWYNCPDP

General Provider Information

NPI Number : 1609859826
Entity Type Code : Organization
Provider Name (Legal Business Name) : 90TH MEDGRP-FE WARREN
Provider Business Mailing Address
First Line : 6900 ALDEN DR
Second Line :
City : FE WARREN AFB
State : WY
Zip : 82005-3906
Country : US
Telephone Number : 307-773-5674
Fax Number : 307-773-6574
Provider Business Practice Location Address
First Line : 6900 ALDEN DR BLDG 160
Second Line :
City : FE WARREN AFB
State : WY
Zip : 82005-2945
Country : US
Telephone Number : 307-773-4855
Fax Number : 307-773-3731
Authorized Official
Title or Position : DHA UBO
Name : JEN LEWANDOWSKI
Credential :
Telephone Number : 703-817-4030
Provider Enumeration Date : 11/22/2005
Last Update Date : 06/17/2025

Similar Medicare Providers

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Directions to “90TH MEDGRP-FE WARREN ” Practice Location

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