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Organization
27TH SPECIAL OPS MEDGRP-CANNON
Active
Organization
27TH SPECIAL OPS MEDGRP-CANNON
Active
Parent organization
27TH SPECIAL OPS MEDGRP-CANNON
Organization subpart
Yes
Provider details
NPI number
Legal business name
27TH SPECIAL OPS MEDGRP-CANNON
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
208 W CASABLANCA AVE, 27 MDSS SGSR, CANNON AFB, NM 88103-5009
(505) 784-4023
(505) 784-7749
Mailing address
208 W CASABLANCA AVE, 27 MDSS SGSR, CANNON AFB, NM 88103-5009
(505) 784-4023
(505) 784-7749
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
NULL
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
NULL
332000000X
Military/U.S. Coast Guard Pharmacy
—
NULL
Other
Enumeration date
02/02/2006
Last updated
06/17/2025
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