# 412TH MEDGRP-EDWARDS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 412TH MEDGRP-EDWARDS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1891765046
- **Legal business name:** 412TH MEDGRP-EDWARDS
- **Authorized official:** JEN LEWANDOWSKI (AIR FORCE UBO ANALYST)
- **Authorized official phone:** (703) 817-4030

## Contact information

- **Practice address:** 30 NIGHTINGALE RD, BLDG 5525, EDWARDS AFB, CA 93524-0001
- **Practice address phone:** (661) 275-2634
- **Practice address fax:** (661) 277-6645
- **Mailing address:** 30 NIGHTINGALE RD, BLDG 5525, EDWARDS AFB, CA 93524-0001
- **Mailing address phone:** (661) 275-2634
- **Mailing address fax:** (661) 277-6645

## Taxonomy

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

## Other

- **Enumeration date:** 01/23/2006
- **Last updated:** 06/16/2025