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Organization
673D MEDGRP-JBER ELMNDRF-RICH
Active
Organization
673D MEDGRP-JBER ELMNDRF-RICH
Active
Parent organization
673D MEDGRP-JBER ELMNDRF-RICH
Other names
Joint Base Elmendorf Richardson MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
673D MEDGRP-JBER ELMNDRF-RICH
Authorized official
JEN LEWANDOWSKI (AIR FORCE UBO ANALYST)
(703) 817-4030
Entity
Organization
Contact information
Practice address
1782 HACKETT DR, LA PINE, OR 97739-9118
(442) 245-4585
Mailing address
25016 HENDON ST, LAGUNA HILLS, CA 92653-4629
(442) 245-4585
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
—
286500000X
Military Hospital
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02-02402
NCPDP
AK
Enumeration date
12/02/2005
Last updated
09/14/2026
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