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Organization
21ST MEDGRP-PETERSON
Active
Organization
21ST MEDGRP-PETERSON
Active
Parent organization
21ST MEDGRP-PETERSON
Other names
Peterson AFB MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
21ST MEDGRP-PETERSON
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
559 VINCENT ST, PETERSON AFB, CO 80914-1541
(719) 556-1250
Mailing address
559 VINCENT ST, PETERSON AFB, CO 80914-1541
(719) 556-1250
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
12/19/2005
Last updated
06/17/2025
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