NPIMap

Organization Active NPI

42D Medgrp-Maxwell

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Maxwell Afb, AL
National Provider Identifier
1033196878
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
42D MEDGRP-MAXWELL
Practice address
300 South Twining St
Building 760
Maxwell Afb, AL 36112-6219
Phone
(334) 953-4943
Fax
(334) 953-1741
NPI assigned
Dec 22, 2005
Organization subpart
Yes
Parent organization
42D MEDGRP-MAXWELLAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jen Lewandowski
Title
Defense Health Agency (Dha) Financi
Phone
(703) 817-4030

Specialties & licenses 3

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

Addresses

Primary practice location

300 South Twining St
Building 760
Maxwell Afb, AL 36112-6219

Mailing address

300 South Twining St
Building 760
Maxwell Afb, AL 36112-6219
Phone (334) 953-4943

Other identifiers 1

IdentifierTypeStateIssuer
0127123OtherALNCPDP

Other names 1

  • Maxwell AFB MTF Other name

National Provider Directory

National Provider Directory
Tax ID family
42D Medgrp-Maxwell4 organizations share this tax ID, including this one
Part of
42D Medgrp-Maxwell

Other organizations with this tax ID 3

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

Locations

300 Twining St
Bldg 760
Montgomery, AL 36112
Phone (334) 953-3368

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1033196878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SOUTH TWINING ST",
            "address_2": "BUILDING 760",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "361126219",
            "telephone_number": "334-953-4943",
            "fax_number": "334-953-1741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SOUTH TWINING ST",
            "address_2": "BUILDING 760",
            "city": "MAXWELL AFB",
            "state": "AL",
            "postal_code": "361126219",
            "telephone_number": "334-953-4943",
            "fax_number": "334-953-1741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "42D MEDGRP-MAXWELL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "42D MEDGRP-MAXWELL",
        "enumeration_date": "2005-12-22",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A",
        "authorized_official_last_name": "LEWANDOWSKI",
        "authorized_official_first_name": "JEN",
        "authorized_official_title_or_position": "DEFENSE HEALTH AGENCY (DHA) FINANCI",
        "authorized_official_telephone_number": "703-817-4030"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0127123",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maxwell AFB MTF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Maxwell Afb, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.