Organization
47TH MEDGRP-LAUGHLIN
Active
Parent organization
47TH MEDGRP-LAUGHLIN
Organization subpart
Yes
Provider details
NPI number
Legal business name
47TH MEDGRP-LAUGHLIN
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
590 MITCHELL BLVD, LAUGHLIN AFB, TX 78843-5242
(830) 398-6320
(830) 298-6439
Mailing address
590 MITCHELL BLVD, 47 MDSS SGSRR, LAUGHLIN AFB, TX 78843-5242
(830) 398-6320
(830) 298-6439
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
—
4510536
NCPDP
TX
Enumeration date
01/09/2006
Last updated
06/17/2025
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