412TH Medgrp-Edwards
Organization Active NPI Military/U.S. Coast Guard Outpatient Clinic/Center · Edwards Afb, CA
NPI 1891765046 · NPPES record last updated Jun 16, 2025
Key facts
- NPI
- 1891765046
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X
- Legal business name
- 412TH MEDGRP-EDWARDS
- Practice address
- 30 Nightingale Rd
BLDG 5525
Edwards Afb, CA 93524-0001 - Phone
- (661) 275-2634
- Fax
- (661) 277-6645
- NPI assigned
- Jan 23, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- 412TH MEDGRP-EDWARDS
Authorized official
- Name
- Jen Lewandowski
- Title
- Air Force Ubo Analyst
- Phone
- (703) 817-4030
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- 412TH Medgrp-Edwards
- Part of
- 412TH Medgrp-Edwards
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military/U.S. Coast Guard Outpatient Clinic/Center | 261QM1100X | Yes | ||
| Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | 261QM1101X | |||
| Military/U.S. Coast Guard Pharmacy | 332000000X |
Addresses
Primary practice location
30 Nightingale Rd
BLDG 5525
Edwards Afb, CA 93524-0001
Mailing address
30 Nightingale Rd
BLDG 5525
Edwards Afb, CA 93524-0001
Phone (661) 275-2634
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05-40345 | Other | CA | NCPDP |
Other providers in Edwards Afb, CA
- 412TH Medgrp-Edwards
- Richard Y. Baird
- Scott Anthony Baker
- Nisha Ray Baur
- Tiffany Byrd
- Stephen Joseph Byrnes
All providers in Edwards Afb, CA · Military/U.S. Coast Guard Outpatient Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.