Organization
45TH MEDGRP-PATRICK
Active
Parent organization
45TH MEDGRP-PATRICK
Other names
Patrick AFB MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
45TH MEDGRP-PATRICK
Authorized official
JEN LEWANDOWSKI (AIR FORCE UBO ANALYST)
(703) 817-4030
Entity
Organization
Contact information
Practice address
1381 S PATRICK DR, PATRICK AFB, FL 32925-3606
(321) 494-8457
(321) 494-7821
Mailing address
1381 S PATRICK DR, PATRICK AFB, FL 32925-3606
(321) 494-8457
(321) 494-7821
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
—
10-80465
NCPDP
FL
Enumeration date
11/30/2005
Last updated
06/16/2025
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