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Organization

5TH MEDGRP-MINOT

Active
Parent organization
5TH MEDGRP-MINOT
Other names
Minot AFB MTF
Organization subpart
Yes

Provider details

NPI number
Legal business name
5TH MEDGRP-MINOT
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization

Contact information

Practice address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(701) 723-5995
(630) 570-6075
Mailing address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(701) 723-5995
(630) 570-6074

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
3503883
NABP/NCPDP
ND
01
70766
BLUE CROSS BLUE SHIELD
ND
01
8664
BLUE CROSS BLUE SHIELD
ND
Enumeration date
11/22/2005
Last updated
04/13/2026
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