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General NPI Number Information
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NPI Number | 1912982810
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Entity Type | Organization
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Legal Business Name | 377TH MEDGRP-KIRTLAND
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2050A SECOND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-5524
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Country | US
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Telephone | 505-846-3605
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Fax | 505-846-3594
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Provider Business Mailing Address
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Address Line | 2050A SECOND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-5524
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Country | US
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Telephone | 505-846-3605
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Fax | 505-846-3594
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Authorized Official
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Title or Position | DHA UBO
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Name | JEN LEWANDOWSKI
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Credential |
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Telephone | 703-817-4030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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