Organization · NPI-2

23d Medgrp-Moody

Clinic/Center, MilitaryU.S. Coast Guard Outpatient · Moody Afb, GA

NPI number1316907744

StatusActive

Last updated in NPPESJun 16, 2025

Details

NPI: 1316907744
Entity type: Organization (NPI-2)
Legal business name: 23d Medgrp-Moody
Organization subpart: Yes
Enumeration date: Mar 28, 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

Moody Afb Mtf (Other Name)

Practice location

3278 Mitchell Blvd
Moody Afb, GA 31699-1500

Phone 229-257-3041 · Fax 229-257-5528

Mailing address

3278 Mitchell Blvd
Moody Afb, GA 31699-1500

Phone 229-257-3041 · Fax 229-257-5528

Authorized official

Jen Lewandowski
Air Force Ubo Analyst
7038174030

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