Provider Demographics
NPI:1710967526
Name:81ST MEDGRP-KEESLER
Entity type:Organization
Organization Name:81ST MEDGRP-KEESLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DHA UBO
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 1:301 FISHER ST
Mailing Address - Street 2:STE 101 RM 1A132
Mailing Address - City:KEESLER AFB
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2508
Mailing Address - Country:US
Mailing Address - Phone:228-377-4526
Mailing Address - Fax:228-377-4559
Practice Address - Street 1:301 FISHER ST
Practice Address - Street 2:STE 101 RM 1A132
Practice Address - City:KEESLER AFB
Practice Address - State:MS
Practice Address - Zip Code:39534-2508
Practice Address - Country:US
Practice Address - Phone:228-377-4526
Practice Address - Fax:228-377-4559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:81ST MEDGRP-KEESLER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-18
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2518338OtherNCPDP