355TH Medgrp-Davis-Monthan

Primary specialty

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

Legal business name

355TH MEDGRP-DAVIS-MONTHAN

Practice address

4175 S Alamo Ave
Tucson, AZ 85707-6097

Phone

(520) 228-1506

Fax

(520) 228-0183

NPI assigned

Jan 17, 2006

Organization subpart

Yes

Parent organization

355TH MEDGRP-DAVIS-MONTHANAs 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

Air Force Uniform Business Office

Phone

(703) 817-4030

Specialties & licenses 3

Addresses

Other identifiers 1

Tax ID family

355TH Medgrp-Davis-Monthan2 organizations share this tax ID, including this one

Part of

355TH Medgrp-Davis-Monthan

Other organizations with this tax ID 1

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

• 355TH Medgrp-Davis-Monthan

  • Military/U.S. Coast Guard Pharmacy
  • Davis Monthan Afb, AZ
  • NPI 1366856155
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Denise Fabian, M.D.

  • Psychiatry Physician
  • Davis Monthan Afb, AZ
  • NPI 1144457045
  NPD

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1245210384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 S ALAMO AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857076097",
            "telephone_number": "520-228-1506",
            "fax_number": "520-228-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 S ALAMO AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857076097",
            "telephone_number": "520-228-1506",
            "fax_number": "520-228-0183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "355TH MEDGRP-DAVIS-MONTHAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "355TH MEDGRP-DAVIS-MONTHAN",
        "enumeration_date": "2006-01-17",
        "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": "AIR FORCE UNIFORM BUSINESS OFFICE",
        "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": "0322103",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Tucson, AZ
• Military/U.S. Coast Guard Outpatient Clinic/Center in Arizona

• 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.