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Organization
509TH MEDGRP-WHITEMAN
Active
Organization
509TH MEDGRP-WHITEMAN
Active
Parent organization
509TH MEDGRP-WHITEMAN
Other names
Whiteman AFB MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
509TH MEDGRP-WHITEMAN
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
331 SIJAN AVE, 509 MDSS SGSR, WHITEMAN AFB, MO 65305-1269
(660) 687-1838
(660) 687-5121
Mailing address
331 SIJAN AVE, 509 MDSS SGSR, WHITEMAN AFB, MO 65305-1269
(660) 687-1838
(660) 687-5121
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2632897
NCPDP
MO
Enumeration date
12/28/2005
Last updated
06/17/2025
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