Organization
355TH MEDGRP-DAVIS-MONTHAN
Active
Parent organization
355TH MEDGRP-DAVIS-MONTHAN
Organization subpart
Yes
Provider details
NPI number
Legal business name
355TH MEDGRP-DAVIS-MONTHAN
Authorized official
JEN LEWANDOWSKI (AIR FORCE UNIFORM BUSINESS OFFICE)
(703) 817-4030
Entity
Organization
Contact information
Practice address
4175 S ALAMO AVE, TUCSON, AZ 85707-6097
(520) 228-1506
(520) 228-0183
Mailing address
4175 S ALAMO AVE, TUCSON, AZ 85707-6097
(520) 228-1506
(520) 228-0183
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
—
0322103
NCPDP
AZ
Enumeration date
01/17/2006
Last updated
06/16/2025
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