MEDICARE: 14TH MEDGRP-COLUMBUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1101X	Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
2	332000000X	Military/U.S. Coast Guard Pharmacy
3	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2520179	OTHER	MS	NCPDP

General Provider Information

NPI Number	:	1487630356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	14TH MEDGRP-COLUMBUS

Provider Business Mailing Address
First Line	:	201 INDEPENDENCE
Second Line	:	SUITE 101
City	:	COLUMBUS
State	:	MS
Zip	:	39710-5300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 INDEPENDENCE
Second Line	:	SUITE 101
City	:	COLUMBUS
State	:	MS
Zip	:	39710-5300
Country	:	US
Telephone Number	:	662-434-2159
Fax Number	:	662-434-2242

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	06/17/2025

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