NPIMap

Organization Active NPI

59TH MDW-Whasc-Lackland

  • Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
  • Lackland a F B, TX
National Provider Identifier
1275511776
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military and U.S. Coast Guard Ambulatory Procedure Clinic/CenterTaxonomy code 261QM1101X
Legal business name
59TH MDW-WHASC-LACKLAND
Practice address
2200 Bergquist Dr
Suite 1 Adbs
Lackland a F B, TX 78236-9907
Phone
(210) 292-7575
Fax
(210) 292-2592
NPI assigned
Jan 4, 2006
Organization subpart
Yes
Parent organization
59TH MDW-WHASC-LACKLANDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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 3

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

Addresses

Primary practice location

2200 Bergquist Dr
Suite 1 Adbs
Lackland a F B, TX 78236-9907

Mailing address

2200 Bergquist Dr
Suite 1 Adbs
Lackland a F B, TX 78236-9907
Phone (210) 292-7575

Other identifiers 3

IdentifierTypeStateIssuer
HH6032OtherTXBLUE CROSS BLUE SHIELD
4596776OtherTXNCPDP
021757201MedicaidTX

Other names 1

  • 59 MDW ADBS Other name

National Provider Directory

National Provider Directory
Tax ID family
Lackland BMT Op Phcy8 organizations share this tax ID, including this one
Part of
Wilford Hall Medical Center

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1275511776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 BERGQUIST DR",
            "address_2": "SUITE 1 ADBS",
            "city": "LACKLAND A F B",
            "state": "TX",
            "postal_code": "782369907",
            "telephone_number": "210-292-7575",
            "fax_number": "210-292-2592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 BERGQUIST DR",
            "address_2": "SUITE 1 ADBS",
            "city": "LACKLAND A F B",
            "state": "TX",
            "postal_code": "782369907",
            "telephone_number": "210-292-7575",
            "fax_number": "210-292-2592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "59TH MDW-WHASC-LACKLAND",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "59TH MDW-WHASC-LACKLAND",
        "enumeration_date": "2006-01-04",
        "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": false
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "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": "BLUE CROSS BLUE SHIELD",
            "identifier": "HH6032",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4596776",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021757201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "59 MDW ADBS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lackland a F B, TX

Sources for this page

  • 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.