Organization · NPI-2
19th Medgrp-Little Rock
Clinic/Center, MilitaryU.S. Coast Guard Outpatient · Lr Afb, AR
NPI number1073591830
StatusActive
Last updated in NPPESJun 16, 2025
Details
- NPI
- 1073591830
- Entity type
- Organization (NPI-2)
- Legal business name
- 19th Medgrp-Little Rock
- Organization subpart
- Yes
- Enumeration date
- Jan 3, 2006
- Certification date
- Jun 16, 2025
- Last updated
- Jun 16, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1100X | Clinic/Center, MilitaryU.S. Coast Guard Outpatient | – | – | Yes |
| 261QM1101X | Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure | – | – | |
| 332000000X | MilitaryU.S. Coast Guard Pharmacy | – | – |
Other names
- Little Rock Afb Mtf (Other Name)
Practice location
1090 Arnold DrLr Afb, AR 72099-4933
Phone 501-987-7414 · Fax 501-987-7310
Mailing address
1090 Arnold DrLr Afb, AR 72099-4933
Phone 501-987-7414 · Fax 501-987-7310
Authorized official
Jen Lewandowski
Air Force Ubo Analyst
7038174030
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