# 17TH MEDGRP-GOODFELLOW

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 17TH MEDGRP-GOODFELLOW
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104805142
- **Legal business name:** 17TH MEDGRP-GOODFELLOW
- **Authorized official:** JEN LEWANDOWSKI (DHA UBO)
- **Authorized official phone:** (703) 817-4030

## Contact information

- **Practice address:** 271 FORT RICHARDSON AVE, GOODFELLOW AFB, TX 76908-4901
- **Practice address phone:** (325) 654-5974
- **Practice address fax:** (325) 654-3121
- **Mailing address:** 271 FORT RICHARDSON AVE, GOODFELLOW AFB, TX 76908-4901
- **Mailing address phone:** (325) 654-5974
- **Mailing address fax:** (325) 654-3121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | TX | Yes |
| 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