Healthcare Provider Details

I. General information

NPI: 1396722955
Provider Name (Legal Business Name): 35TH MEDGRP-MISAWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MDSS SGSR UNIT 5024 ATTN MEDICAL SERVICE ACCOUNTS
APO AP
96319 5024
US

IV. Provider business mailing address

35 MDSS SGSR UNIT 5024 ATTN MEDICAL SERVICE ACCOUNTS
APO AP
96319 5024
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-6250
  • Fax:
Mailing address:
  • Phone: 315-226-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: JEN LEWANDOWSKI
Title or Position: DHA FINANCIAL MANAGER
Credential:
Phone: 703-817-4030