Organization
377TH MEDGRP-KIRTLAND
Active
Parent organization
377TH MEDGRP-KIRTLAND
Organization subpart
Yes
Provider details
NPI number
Legal business name
377TH MEDGRP-KIRTLAND
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
2050A SECOND ST SE, KIRTLAND AFB, NM 87117-5524
(505) 846-3605
(505) 846-3594
Mailing address
2050A SECOND ST SE, KIRTLAND AFB, NM 87117-5524
(505) 846-3605
(505) 846-3594
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32-08926
NCPDP
NM
Enumeration date
12/13/2005
Last updated
06/17/2025
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