NPIMap

Organization Active NPI

21St Medgrp-Peterson

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Peterson AFB, CO
National Provider Identifier
1942286224
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X
Legal business name
21ST MEDGRP-PETERSON
Practice address
559 Vincent St
Peterson AFB, CO 80914-1541
Phone
(719) 556-1250
NPI assigned
Dec 19, 2005
Organization subpart
Yes
Parent organization
21ST MEDGRP-PETERSONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
Military/U.S. Coast Guard Outpatient Clinic/Center 261QM1100X Primary
Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center 261QM1101X
Military/U.S. Coast Guard Pharmacy 332000000X

Addresses

Primary practice location

559 Vincent St
Peterson AFB, CO 80914-1541

Mailing address

559 Vincent St
Peterson AFB, CO 80914-1541
Phone (719) 556-1250

Other identifiers 2

IdentifierTypeStateIssuer
1548369259OtherCONPPES
06-16788OtherCONCPDP

Other names 1

  • Peterson AFB MTF Other name

National Provider Directory

National Provider Directory
Tax ID family
21 Medical Group6 organizations share this tax ID, including this one
Part of
21 Medical Group

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1942286224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-556-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 VINCENT ST",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141541",
            "telephone_number": "719-556-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "21ST MEDGRP-PETERSON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "21ST MEDGRP-PETERSON",
        "enumeration_date": "2005-12-19",
        "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": "NPPES",
            "identifier": "1548369259",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "06-16788",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson AFB MTF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Peterson AFB, CO

Sources for this page

  • 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.