Active NPI
20TH Medgrp-Shaw
- Military/U.S. Coast Guard Outpatient Clinic/Center
- Shaw AFB, SC
National Provider Identifier
1336112440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military/U.S. Coast Guard Outpatient Clinic/Center
- Legal business name
- 20TH MEDGRP-SHAW
- Practice address
- 431 Meadowlark St
Shaw AFB, SC 29152-5019 - Phone
- (803) 895-6526
- Fax
- (803) 895-6419
- NPI assigned
- Feb 9, 2006
- Last updated
- Jun 17, 2025
- Organization subpart
- Yes
- Parent organization
- 20TH MEDGRP-SHAW
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Military/U.S. Coast Guard Outpatient Clinic/Center | 261QM1100X | NU | Primary | |
| Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | 261QM1101X | NU | ||
| Military/U.S. Coast Guard Pharmacy | 332000000X | NU |
Addresses
Primary practice location
431 Meadowlark St
Shaw AFB, SC 29152-5019
Mailing address
431 Meadowlark St
Shaw AFB, SC 29152-5019
Phone (803) 895-6526
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4222903 | Other | SC | NCPDP |
National Provider Directory
National Provider Directory- Tax ID family
- 20TH Medgrp-Shaw
- Part of
- 20TH Medgrp-Shaw
Other organizations with this tax ID 1
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": "1139443200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750118400000",
"number": "1336112440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "431 MEADOWLARK ST",
"city": "SHAW AFB",
"state": "SC",
"postal_code": "291525019",
"telephone_number": "803-895-6526",
"fax_number": "803-895-6419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "431 MEADOWLARK ST",
"city": "SHAW AFB",
"state": "SC",
"postal_code": "291525019",
"telephone_number": "803-895-6526",
"fax_number": "803-895-6419"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "20TH MEDGRP-SHAW",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "20TH MEDGRP-SHAW",
"enumeration_date": "2006-02-09",
"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": "4222903",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shaw AFB, SC
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.