Organization
71ST MEDGRP-VANCE
Active
Parent organization
71ST MEDGRP-VANCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
71ST MEDGRP-VANCE
Authorized official
JEN LEWANDOWSKI (DEFENSE HEALTH AGENCY (DHA) FINANCI)
(703) 817-4030
Entity
Organization
Contact information
Practice address
527 GOTT RD, ENID, OK 73705-5103
(580) 213-7907
Mailing address
527 GOTT RD, ENID, OK 73705-5103
(580) 213-7907
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
—
3722267
NCPDP
OK
Enumeration date
01/03/2006
Last updated
06/17/2025
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