Organization
96TH MEDGRP-EGLIN
Active
Parent organization
96TH MEDGRP-EGLIN
Other names
96th Medical Support Squadron or 96 MDSS SGSR
Organization subpart
Yes
Provider details
NPI number
Legal business name
96TH MEDGRP-EGLIN
Authorized official
JEN LEWANDOWSKI (AIR FORCE UNIFORM BUSINESS OFFICE)
(703) 817-4030
Entity
Organization
Contact information
Practice address
307 BOATNER RD, SUITE 114, EGLIN AFB, FL 32542-1302
(850) 883-9015
(850) 883-8659
Mailing address
307 BOATNER RD, SUITE 114, EGLIN AFB, FL 32542-1302
(850) 883-9015
(850) 883-8659
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
—
—
2865M2000X
Military General Acute Care Hospital
Primary
—
—
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10-79260
NCPDP
FL
Enumeration date
11/22/2005
Last updated
06/16/2025
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