354TH Medgrp-Eielson

Primary specialty

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

Legal business name

354TH MEDGRP-EIELSON

Practice address

2630 Central Ave
Suite 1M07
Eielson AFB, AK 99702-2325

Phone

(907) 377-6579

NPI assigned

Mar 28, 2006

Last updated

Jun 17, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

354TH MEDGRP-EIELSONAs 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

• Eielson AFB MTF Other name

Tax ID family

354TH Medgrp-Eielson2 organizations share this tax ID, including this one

Part of

354TH Medgrp-Eielson

Other organizations with this tax ID 1

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

• 354TH Medgrp-Eielson

  dba Dod Eielson Pharmacy

  • Military/U.S. Coast Guard Pharmacy
  • Eielson AFB, AK
  • NPI 1902218415
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Hawthorne Ramage, M.D.

  • Family Medicine Physician
  • Texarkana, TX
  • NPI 1558568253
  NPD

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1902867229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE",
            "address_2": "SUITE 1M07",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022325",
            "telephone_number": "907-377-6579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE",
            "address_2": "SUITE 1M07",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022325",
            "telephone_number": "907-377-6579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "354TH MEDGRP-EIELSON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "354TH MEDGRP-EIELSON",
        "enumeration_date": "2006-03-28",
        "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": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "02-02399",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eielson AFB MTF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• 354TH Medgrp-Eielson (Dod Eielson Pharmacy)
• Anna Elizabeth J. S. Allen, DDS
• Dayne Kawika Bonzo, DO
• Daniel Braswell, PT, DPT, CSCS
• Kelsey Gene Broome, PHYSICIAN ASSISTANT
• Angelia Deanne Calder, EMT-B, PHTLS, ACLS,

• Military/U.S. Coast Guard Outpatient Clinic/Center in Eielson AFB, AK
• Providers in Eielson AFB, AK by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in Alaska

• 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.