366th Medgrp-Mountain Home
NPI #1063487791 in Mountain Home Afb, Idaho
Provider Information
- NPI Number
- 1063487791
- Entity Type
- Organization
- Organization Name
- 366th Medgrp-Mountain Home
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- 366TH MEDGRP-MOUNTAIN HOME
- Primary Specialty
- Clinic/Center - Military and U.S. Coast Guard Ambulatory Procedure
- Enumeration Date
- Feb 17, 2006
- Last Updated
- Jun 17, 2025
Practice Location
- Address
- 90 HOPE DRIVE BLDG 6000
- Address 2
- 366 MEDICAL GROUP
- State
- Idaho
- ZIP Code
- 83648-1062
- Phone
- (208) 828-7470
Authorized Official
- Name
- JEN LEWANDOWSKI
- Title
- DHA UBO
- Phone
- (703) 817-4030
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Military/U.S. Coast Guard Outpatient — Military/U.S. Coast Guard Outpatient |
| Military/U.S. Coast Guard Pharmacy |
| Clinic/Center - Military and U.S. Coast Guard Ambulatory Procedure — Military and U.S. Coast Guard Ambulatory Procedure |
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