MEDICARE: 72D MEDGRP-TINKER

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
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1285618363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	72D MEDGRP-TINKER

Provider Business Mailing Address
First Line	:	7050 AIR DEPOT TINKER AFB
Second Line	:	BUILDING 1094
City	:	TINKER AFB
State	:	OK
Zip	:	73145
Country	:	US
Telephone Number	:	405-582-6035
Fax Number	:	405-736-3892

Provider Business Practice Location Address
First Line	:	7050 AIR DEPOT TINKER AFB
Second Line	:	BUILDING 1094
City	:	TINKER AFB
State	:	OK
Zip	:	73145
Country	:	US
Telephone Number	:	405-582-6033
Fax Number	:	405-736-3892

Authorized Official
Title or Position	:	DHA UBO
Name	:	JEN LEWANDOWSKI
Credential	:
Telephone Number	:	703-817-4030

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	06/17/2025

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Directions to “72D MEDGRP-TINKER ” Practice Location

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