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Organization
17TH MEDGRP-GOODFELLOW
Active
Organization
17TH MEDGRP-GOODFELLOW
Active
Parent organization
17TH MEDGRP-GOODFELLOW
Organization subpart
Yes
Provider details
NPI number
Legal business name
17TH MEDGRP-GOODFELLOW
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
271 FORT RICHARDSON AVE, GOODFELLOW AFB, TX 76908-4901
(325) 654-5974
(325) 654-3121
Mailing address
271 FORT RICHARDSON AVE, GOODFELLOW AFB, TX 76908-4901
(325) 654-5974
(325) 654-3121
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
TX
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
NULL
332000000X
Military/U.S. Coast Guard Pharmacy
—
NULL
Other
Enumeration date
01/10/2006
Last updated
06/17/2025
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