Organization
28TH MEDGRP-ELLSWORTH
Active
Parent organization
28TH MEDGRP-ELLSWORTH
Other names
Ellsworth AFB MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
28TH MEDGRP-ELLSWORTH
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
(605) 385-3311
(605) 385-3234
Mailing address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
(605) 385-3311
(605) 385-3234
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4304969
NCPDP
SD
05
—
5351000
—
SD
Enumeration date
11/29/2005
Last updated
06/17/2025
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