Organization
59TH MDW-WHASC-LACKLAND
Active
Parent organization
59TH MDW-WHASC-LACKLAND
Other names
59 MDW ADBS
Organization subpart
Yes
Provider details
NPI number
Legal business name
59TH MDW-WHASC-LACKLAND
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
2200 BERGQUIST DR, SUITE 1 ADBS, LACKLAND A F B, TX 78236-9907
(210) 292-7575
(210) 292-2592
Mailing address
2200 BERGQUIST DR, SUITE 1 ADBS, LACKLAND A F B, TX 78236-9907
(210) 292-7575
(210) 292-2592
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QM1101X
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
Primary
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021757201
—
TX
01
—
4596776
NCPDP
TX
01
—
HH6032
BLUE CROSS BLUE SHIELD
TX
Enumeration date
01/04/2006
Last updated
06/17/2025
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