Organization
49TH MEDGRP-HOLLOMAN
Active
Parent organization
49TH MEDGRP-HOLLOMAN
Other names
Holloman AFB MTF
Organization subpart
Yes
Provider details
NPI number
Legal business name
49TH MEDGRP-HOLLOMAN
Authorized official
JEN LEWANDOWSKI (DHA UBO)
(703) 817-4030
Entity
Organization
Contact information
Practice address
280 1ST ST, SGSR, HOLLOMAN AFB, NM 88330-8273
(505) 572-5744
(505) 572-0549
Mailing address
280 1ST ST, SGSR, HOLLOMAN AFB, NM 88330-8273
(505) 572-5744
(505) 572-0549
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
—
3210010
NCPDP
NM
Enumeration date
02/09/2006
Last updated
07/03/2025
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