# 28TH MEDGRP-ELLSWORTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 28TH MEDGRP-ELLSWORTH
- **Other names:** Ellsworth AFB MTF
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1023091642
- **Legal business name:** 28TH MEDGRP-ELLSWORTH
- **Authorized official:** JEN LEWANDOWSKI (DHA UBO)
- **Authorized official phone:** (703) 817-4030

## Contact information

- **Practice address:** 2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
- **Practice address phone:** (605) 385-3311
- **Practice address fax:** (605) 385-3234
- **Mailing address:** 2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
- **Mailing address phone:** (605) 385-3311
- **Mailing address fax:** (605) 385-3234

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | — | Yes |
| 261QM1101X | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | — | — | — |
| 332000000X | Military/U.S. Coast Guard Pharmacy | — | — | — |

## Other

- **Enumeration date:** 11/29/2005
- **Last updated:** 06/17/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4304969 | NCPDP | SD |
| 05 | — | 5351000 | — | SD |