Provider Demographics
NPI:1316919160
Name:55TH MEDGRP-OFFUTT
Entity type:Organization
Organization Name:55TH MEDGRP-OFFUTT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEFENSE HEALTH AGENCY (DHA) FINANCI
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-817-4030
Mailing Address - Street 1:2501 CAPEHART RD
Mailing Address - Street 2:STE 105
Mailing Address - City:OFFUTT A F B
Mailing Address - State:NE
Mailing Address - Zip Code:68113-1043
Mailing Address - Country:US
Mailing Address - Phone:402-294-9215
Mailing Address - Fax:402-294-7463
Practice Address - Street 1:2501 CAPEHART RD
Practice Address - Street 2:STE 105
Practice Address - City:OFFUTT A F B
Practice Address - State:NE
Practice Address - Zip Code:68113-1043
Practice Address - Country:US
Practice Address - Phone:402-294-9215
Practice Address - Fax:402-294-7463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:55TH MEDGRP-OFFUTT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-06
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2815706OtherNCPDP