Organization · NPI-2
21st Medgrp-Peterson
Clinic/Center, MilitaryU.S. Coast Guard Outpatient · Peterson Afb, CO
NPI number1942286224
StatusActive
Last updated in NPPESJun 17, 2025
Details
- NPI
- 1942286224
- Entity type
- Organization (NPI-2)
- Legal business name
- 21st Medgrp-Peterson
- Organization subpart
- Yes
- Enumeration date
- Dec 19, 2005
- 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 | – | – |
Other names
- Peterson Afb Mtf (Other Name)
Practice location
559 Vincent StPeterson Afb, CO 80914-1541
Phone 719-556-1250
Mailing address
559 Vincent StPeterson Afb, CO 80914-1541
Phone 719-556-1250
Authorized official
Jen Lewandowski
Dha Ubo
7038174030
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