Healthcare Provider Details

I. General information

NPI: 1205896701
Provider Name (Legal Business Name): 60TH MEDGRP-TRAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR 60TH MEDICAL GROUP
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR 60TH MEDICAL GROUP
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-451-7913
  • Fax: 707-423-7574
Mailing address:
  • Phone: 707-451-7913
  • Fax: 707-423-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER LEWANDOWSKI
Title or Position: AIR FORCE UBO ANALYST
Credential:
Phone: 703-817-4030