Organization
460TH MEDGRP-BUCKLEY
Active
Parent organization
460TH MEDGRP-BUCKLEY
Other names
460th Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
460TH MEDGRP-BUCKLEY
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
275 S ASPEN ST STOP 89, AURORA, CO 80011-9562
(720) 277-9493
Mailing address
275 S ASPEN ST STOP 89, AURORA, CO 80011-9562
(720) 277-9493
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
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
—
06-16790
NCPDP
CO
01
—
1932206786
NPPES
CO
Enumeration date
11/30/2005
Last updated
06/17/2025
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