412TH Medgrp-Edwards

Primary specialty

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

Last updated

Jun 16, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

412TH MEDGRP-EDWARDSAs 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

Air Force Ubo Analyst

Phone

(703) 817-4030

Specialties & licenses 3

Addresses

Tax ID family

412TH Medgrp-Edwards2 organizations share this tax ID, including this one

Part of

412TH Medgrp-Edwards

Other organizations with this tax ID 1

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

• 412TH Medgrp-Edwards

  dba Dod Edwards Pharmacy

  • Military/U.S. Coast Guard Pharmacy
  • Edwards AFB, CA
  • NPI 1548673163
  NPD tax ID

Locations

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1891765046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 NIGHTINGALE RD",
            "address_2": "BLDG 5525",
            "city": "EDWARDS AFB",
            "state": "CA",
            "postal_code": "935240001",
            "telephone_number": "661-275-2634",
            "fax_number": "661-277-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 NIGHTINGALE RD",
            "address_2": "BLDG 5525",
            "city": "EDWARDS AFB",
            "state": "CA",
            "postal_code": "935240001",
            "telephone_number": "661-275-2634",
            "fax_number": "661-277-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "412TH MEDGRP-EDWARDS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "412TH MEDGRP-EDWARDS",
        "enumeration_date": "2006-01-23",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A",
        "authorized_official_last_name": "LEWANDOWSKI",
        "authorized_official_first_name": "JEN",
        "authorized_official_title_or_position": "AIR FORCE UBO ANALYST",
        "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": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 412TH Medgrp-Edwards (Dod Edwards Pharmacy)
• Richard Y. Baird, O.D
• Scott Anthony Baker, PHARMD
• Nisha Ray Baur, DO
• Tiffany Byrd, M.D.
• Stephen Joseph Byrnes, O.D.

• Military/U.S. Coast Guard Outpatient Clinic/Center in Edwards AFB, CA
• Providers in Edwards AFB, CA by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.