27TH Special Ops Medgrp-Cannon

Primary specialty

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

Legal business name

27TH SPECIAL OPS MEDGRP-CANNON

Practice address

208 W Casablanca Ave
27 MDSS SGSR
Cannon AFB, NM 88103-5009

Phone

(505) 784-4023

Fax

(505) 784-7749

NPI assigned

Feb 2, 2006

Last updated

Jun 17, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

27TH SPECIAL OPS MEDGRP-CANNONAs 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 3

Addresses

Other identifiers 1

Tax ID family

27TH Special Ops Medgrp-Cannon2 organizations share this tax ID, including this one

Part of

27TH Special Ops Medgrp-Cannon

Other organizations with this tax ID 1

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

• 27TH Special Ops Medgrp-Cannon

  dba DoD CANNON ePhcy

  • Military/U.S. Coast Guard Pharmacy
  • Cannon AFB, NM
  • NPI 1417356072
  NPD tax ID

Locations

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1285606384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 W CASABLANCA AVE",
            "address_2": "27 MDSS SGSR",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "881035009",
            "telephone_number": "505-784-4023",
            "fax_number": "505-784-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 W CASABLANCA AVE",
            "address_2": "27 MDSS SGSR",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "881035009",
            "telephone_number": "505-784-4023",
            "fax_number": "505-784-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "27TH SPECIAL OPS MEDGRP-CANNON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "27TH SPECIAL OPS MEDGRP-CANNON",
        "enumeration_date": "2006-02-02",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3210185",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 27TH Special Ops Medgrp-Cannon (DoD CANNON ePhcy)
• Kate Blessie Acob
• Emmanuel Parker Afari, PA
• Desiree Anderson, IDMT
• Elisha Apawan

• Military/U.S. Coast Guard Outpatient Clinic/Center in Cannon AFB, NM
• Providers in Cannon AFB, NM by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in New Mexico

• 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.