National Provider Identifier Database

28TH MEDGRP ELLSWORTH
Military/U.S. Coast Guard Outpatient

The Defense Health Program or U.S. Coast Guard funded ?fixed? facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A ?fixed? facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the ?fixed? facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.


Contact Information

28TH MEDGRP-ELLSWORTH
2900 DOOLITTLE DR
ELLSWORTH AFB, SD57706-4821
Phone: 605-385-3311
Fax: 605-385-3234
Website:
Specialty Taxonomy Code
* Military/U.S. Coast Guard Outpatient 261QM1100X
Military and U.S. Coast Guard Ambulatory Procedure 261QM1101X
Military/U.S. Coast Guard Pharmacy 332000000X

* Indicates primary specialty

NPI Profile & details for 28TH MEDGRP-ELLSWORTH

NPI Number 1023091642
Legal business name
LBN
28TH MEDGRP-ELLSWORTH
Authorized official JEN LEWANDOWSKI - (DHA UBO)
Entity Organization
Organization subpart Yes
Enumeration date 11/29/2005
Last updated 06/17/2025 - About 12 months ago
Sole proprietor1 Not specified
Identifiers
  • SD Medicaid: 5351000
  • SD Other: 4304969 NCPDP

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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