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.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Military/U.S. Coast Guard Outpatient |
261QM1100X | |||
Military and U.S. Coast Guard Ambulatory Procedure |
261QM1101X | |||
Military/U.S. Coast Guard Pharmacy |
332000000X | 87 | All Other Suppliers |
| NPI Number | 1114905775 |
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| LBN Legal business name | 628TH MEDGRP-CHARLESTON | ||||
| Authorized official | JEN LEWANDOWSKI - (DHA UBO) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | Yes | ||||
| Enumeration date | 01/04/2006 | ||||
| Last updated | 06/17/2025 - About 12 months ago | ||||
| Identifiers |
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