Healthcare Provider Details

I. General information

NPI: 1609859826
Provider Name (Legal Business Name): FE WARREN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ALDEN DR BLDG 160
FE WARREN AFB WY
82005-2945
US

IV. Provider business mailing address

6900 ALDEN DR
FE WARREN AFB WY
82005-2945
US

V. Phone/Fax

Practice location:
  • Phone: 307-773-4855
  • Fax: 307-773-3731
Mailing address:
  • Phone: 307-773-5674
  • Fax: 307-773-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1101X
TaxonomyMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

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