97TH Medgrp-Altus

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

97TH MEDGRP-ALTUS

Practice address

301 N 1St St
BLDG 46
Altus Afb, OK 73523-5004

Phone

(580) 481-5400

Fax

(580) 481-5416

NPI assigned

Mar 1, 2006

Organization subpart

Yes

Parent organization

97TH MEDGRP-ALTUSAs reported in NPPES

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

Authorized official

Name

Jen Lewandowski

Title

Dha Ubo

Phone

(703) 817-4030

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

97TH Medgrp-Altus

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1093782880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 N 1ST ST",
            "address_2": "BLDG 46",
            "city": "ALTUS AFB",
            "state": "OK",
            "postal_code": "735235004",
            "telephone_number": "580-481-5400",
            "fax_number": "580-481-5416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N 1ST ST",
            "address_2": "BLDG 46",
            "city": "ALTUS AFB",
            "state": "OK",
            "postal_code": "735235004",
            "telephone_number": "580-481-5400",
            "fax_number": "580-481-5416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "97TH MEDGRP-ALTUS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "97TH MEDGRP-ALTUS",
        "enumeration_date": "2006-03-01",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A",
        "authorized_official_last_name": "LEWANDOWSKI",
        "authorized_official_first_name": "JEN",
        "authorized_official_title_or_position": "DHA UBO",
        "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
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3720225",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 97TH Medgrp-Altus
• Altus Phcy 97TH MDG
• Tiffany Joyce Brilinski, IDMT
• Christian Aric Carroll
• Sunnye Elizabeth Cope, LCSW

• Military/U.S. Coast Guard Outpatient Clinic/Center in Altus Afb, OK
• Providers in Altus Afb, OK by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.