319TH Medgrp-Grand Forks

Primary specialty

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

Legal business name

319TH MEDGRP-GRAND FORKS

Practice address

1599 J St
Grand Forks AFB, ND 58205-6306

Phone

(701) 747-5376

NPI assigned

Mar 27, 2006

Last updated

Jun 17, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

319TH MEDGRP-GRAND FORKSAs 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

Other names 1

• Grand Forks MTF Other name

Tax ID family

319TH Medgrp-Grand Forks2 organizations share this tax ID, including this one

Part of

319TH Medgrp-Grand Forks

Other organizations with this tax ID 1

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

• 319TH Medgrp-Grand Forks

  dba Dod Grand Forks Pharmacy

  • Military/U.S. Coast Guard Pharmacy
  • Grand Forks AFB, ND
  • NPI 1104231091
  NPD tax ID

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1578523924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1599 J ST",
            "city": "GRAND FORKS AFB",
            "state": "ND",
            "postal_code": "582056306",
            "telephone_number": "701-747-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1599 J ST",
            "city": "GRAND FORKS AFB",
            "state": "ND",
            "postal_code": "582056306",
            "telephone_number": "701-747-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "319TH MEDGRP-GRAND FORKS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "319TH MEDGRP-GRAND FORKS",
        "enumeration_date": "2006-03-27",
        "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": "35-03922",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Forks MTF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• 319TH Medgrp-Grand Forks (Dod Grand Forks Pharmacy)
• Romi Abouzedan, DPT
• Joseph Roland Adamson, MD
• Pishoi S Boctor
• Philip Ofimiano Borde Jr., IDMT
• Jenna Marie Boyd, DPT

• Military/U.S. Coast Guard Outpatient Clinic/Center in Grand Forks AFB, ND
• Providers in Grand Forks AFB, ND by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in North Dakota

• 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.