NPIMap

509TH Medgrp-Whiteman

Organization Active NPI Military/U.S. Coast Guard Outpatient Clinic/Center · Whiteman Afb, MO

NPI 1033196480 · NPPES record last updated Jun 17, 2025

Key facts

NPI
1033196480
Entity type
Organization (NPI type 2)
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X
Legal business name
509TH MEDGRP-WHITEMAN
Practice address
331 Sijan Ave
509 MDSS SGSR
Whiteman Afb, MO 65305-1269
Phone
(660) 687-1838
Fax
(660) 687-5121
NPI assigned
Dec 28, 2005
Organization subpart
Yes
Parent organization (as reported)
509TH MEDGRP-WHITEMAN

Authorized official

Name
Jen Lewandowski
Title
Dha Ubo
Phone
(703) 817-4030

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
509TH Medgrp-Whiteman (2 organizations share this tax ID)
Part of
509TH Medgrp-Whiteman

Locations

331 Sijen Ave
#509
Whiteman AFB, MO 65305
Phone (660) 687-1194

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Yes
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center 261QM1101X
Military/U.S. Coast Guard Pharmacy 332000000X

Addresses

Primary practice location

331 Sijan Ave
509 MDSS SGSR
Whiteman Afb, MO 65305-1269

Mailing address

331 Sijan Ave
509 MDSS SGSR
Whiteman Afb, MO 65305-1269
Phone (660) 687-1838

Other identifiers

IdentifierTypeStateIssuer
2632897OtherMONCPDP

Other names

  • Whiteman AFB MTF Other name

Other providers in Whiteman Afb, MO

All providers in Whiteman Afb, MO · Military/U.S. Coast Guard Outpatient Clinic/Center in Missouri

Sources for this page

Verify at the official NPI Registry.