Organization · NPI-2
20th Medgrp-Shaw
Clinic/Center, MilitaryU.S. Coast Guard Outpatient · Shaw Afb, SC
NPI number1336112440
StatusActive
Last updated in NPPESJun 17, 2025
Details
- NPI
- 1336112440
- Entity type
- Organization (NPI-2)
- Legal business name
- 20th Medgrp-Shaw
- Organization subpart
- Yes
- Enumeration date
- Feb 9, 2006
- Certification date
- Jun 17, 2025
- Last updated
- Jun 17, 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 | – | – |
Practice location
431 Meadowlark StShaw Afb, SC 29152-5019
Phone 803-895-6526 · Fax 803-895-6419
Mailing address
431 Meadowlark StShaw Afb, SC 29152-5019
Phone 803-895-6526 · Fax 803-895-6419
Authorized official
Jen Lewandowski
Dha Ubo
7038174030
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