# 42D MEDGRP-MAXWELL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 42D MEDGRP-MAXWELL
- **Other names:** Maxwell AFB MTF
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033196878
- **Legal business name:** 42D MEDGRP-MAXWELL
- **Authorized official:** JEN LEWANDOWSKI (DEFENSE HEALTH AGENCY (DHA) FINANCI)
- **Authorized official phone:** (703) 817-4030

## Contact information

- **Practice address:** 300 SOUTH TWINING ST, BUILDING 760, MAXWELL AFB, AL 36112-6219
- **Practice address phone:** (334) 953-4943
- **Practice address fax:** (334) 953-1741
- **Mailing address:** 300 SOUTH TWINING ST, BUILDING 760, MAXWELL AFB, AL 36112-6219
- **Mailing address phone:** (334) 953-4943
- **Mailing address fax:** (334) 953-1741

## 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:** 12/22/2005
- **Last updated:** 06/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0127123 | NCPDP | AL |