375TH Medgrp-Scott

Primary specialty

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

Legal business name

375TH MEDGRP-SCOTT

Practice address

310 W Losey St
Scott Afb, IL 62225-5250

Phone

(618) 256-7392

NPI assigned

Nov 14, 2005

Organization subpart

Yes

Parent organization

375TH MEDGRP-SCOTTAs 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

Tax ID family

375TH Medgrp-Scott3 organizations share this tax ID, including this one

Part of

375TH Medgrp-Scott

Other organizations with this tax ID 2

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

• 375TH Medgrp-Scott

  • Military/U.S. Coast Guard Pharmacy
  • Scott Afb, IL
  • NPI 1790190940
  NPD tax ID
• 375TH Medgrp-Scott

  • Military Hospital
  • Scott Afb, IL
  • NPI 1861478448
  NPD tax ID

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

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1851373161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-7392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-7392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "375TH MEDGRP-SCOTT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "375TH MEDGRP-SCOTT",
        "enumeration_date": "2005-11-14",
        "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": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "286500000X",
            "taxonomy_group": "",
            "desc": "Military Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 375TH Medgrp-Scott
• 375TH Medgrp-Scott
• Hattie D Alexander, D.O.
• Nicole Andreoli, MT(ASCP)
• Kristine Eva Andrews, M.D.
• Diane Beckius Archbold, DDS

• All providers in Scott Afb, IL
• Military/U.S. Coast Guard Outpatient Clinic/Center in Illinois

• 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.