Organization
22D MEDGRP-MCCONNELL
Active
Parent organization
22D MEDGRP-MCCONNELL
Other names
McConnell AFB MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
22D MEDGRP-MCCONNELL
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
57950 LEAVENWORTH ST 6E4, MCCONNELL AFB, KS 67221-3506
(316) 759-5000
(316) 759-5038
Mailing address
57950 LEAVENWORTH ST 6E4, MCCONNELL AFB, KS 67221-3506
(316) 759-5000
(316) 759-5038
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
—
17-17517
NCPDP
KS
Enumeration date
03/23/2006
Last updated
06/17/2025
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