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That part of a ?fixed? (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial ?take home? pharmaceuticals.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Military and U.S. Coast Guard Ambulatory Procedure |
261QM1101X | |||
Military/U.S. Coast Guard Outpatient |
261QM1100X | |||
Military/U.S. Coast Guard Pharmacy |
332000000X | 87 | All Other Suppliers |
| NPI # | 1063487791 |
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| LBN Legal business name | 366TH MEDGRP-MOUNTAIN HOME | ||||||||
| Authorized official | JEN LEWANDOWSKI - (DHA UBO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | Yes | ||||||||
| Enumeration date | 02/17/2006 | ||||||||
| Last updated | 06/17/2025 - About 12 months ago | ||||||||
| Identifiers |
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366TH MEDGRP-MOUNTAIN HOME