National Provider Identifier Database

21ST MEDGRP PETERSON
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

21ST MEDGRP-PETERSON
559 VINCENT ST
PETERSON AFB, CO80914-1541
Phone: 719-556-1250
Fax:
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 21ST MEDGRP-PETERSON

NPI Number 1942286224
Legal business name
LBN
21ST MEDGRP-PETERSON
Authorized official JEN LEWANDOWSKI - (DHA UBO)
Entity Organization
Organization subpart Yes
Enumeration date 12/19/2005
Last updated 06/17/2025 - About 12 months ago
Sole proprietor1 Not specified
Identifiers
  • CO Other: 06-16788 NCPDP
  • CO Other: 1548369259 NPPES

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.

Reviews for 21ST MEDGRP-PETERSON

There are currently no reviews for 21ST MEDGRP-PETERSON


NPIdb - Home
v2.201