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Organization
412TH MEDGRP-EDWARDS
Active
Organization
412TH MEDGRP-EDWARDS
Active
Parent organization
412TH MEDGRP-EDWARDS
Organization subpart
Yes
Provider details
NPI number
Legal business name
412TH MEDGRP-EDWARDS
Authorized official
JEN LEWANDOWSKI (AIR FORCE UBO ANALYST)
(703) 817-4030
Entity
Organization
Contact information
Practice address
30 NIGHTINGALE RD, BLDG 5525, EDWARDS AFB, CA 93524-0001
(661) 275-2634
(661) 277-6645
Mailing address
30 NIGHTINGALE RD, BLDG 5525, EDWARDS AFB, CA 93524-0001
(661) 275-2634
(661) 277-6645
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
01/23/2006
Last updated
06/16/2025
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