# 96TH MEDGRP-EGLIN

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 96TH MEDGRP-EGLIN
- **Other names:** 96th Medical Support Squadron or 96 MDSS SGSR
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588647770
- **Legal business name:** 96TH MEDGRP-EGLIN
- **Authorized official:** JEN LEWANDOWSKI (AIR FORCE UNIFORM BUSINESS OFFICE)
- **Authorized official phone:** (703) 817-4030

## Contact information

- **Practice address:** 307 BOATNER RD, SUITE 114, EGLIN AFB, FL 32542-1302
- **Practice address phone:** (850) 883-9015
- **Practice address fax:** (850) 883-8659
- **Mailing address:** 307 BOATNER RD, SUITE 114, EGLIN AFB, FL 32542-1302
- **Mailing address phone:** (850) 883-9015
- **Mailing address fax:** (850) 883-8659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | — | NULL | — |
| 261QM1101X | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | — | NULL | — |
| 2865M2000X | Military General Acute Care Hospital | — | NULL | Yes |
| 332000000X | Military/U.S. Coast Guard Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/22/2005
- **Last updated:** 06/16/2025