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Organization

92D MEDGRP-FAIRCHILD

Active
Parent organization
92D MEDGRP-FAIRCHILD
Other names
Fairchild AFB MTF
Organization subpart
Yes

Provider details

NPI number
Legal business name
92D MEDGRP-FAIRCHILD
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization

Contact information

Practice address
701 HOSPITAL LOOP, FAIRCHILD AFB, WA 99011-8704
(509) 247-9264
(509) 247-3535
Mailing address
701 HOSPITAL LOOP, FAIRCHILD AFB, WA 99011-8704
(509) 247-9264
(509) 247-3535

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
49-24507
NCPDP
WA
Enumeration date
04/04/2006
Last updated
06/17/2025
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