Organization
42D MEDGRP-MAXWELL
Active
Parent organization
42D MEDGRP-MAXWELL
Other names
Maxwell AFB MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
42D MEDGRP-MAXWELL
Authorized official
JEN LEWANDOWSKI (DEFENSE HEALTH AGENCY (DHA) FINANCI)
(703) 817-4030
Entity
Organization
Contact information
Practice address
300 SOUTH TWINING ST, BUILDING 760, MAXWELL AFB, AL 36112-6219
(334) 953-4943
(334) 953-1741
Mailing address
300 SOUTH TWINING ST, BUILDING 760, MAXWELL AFB, AL 36112-6219
(334) 953-4943
(334) 953-1741
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
—
0127123
NCPDP
AL
Enumeration date
12/22/2005
Last updated
06/16/2025
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