366Th Medgrp-Mountain Home

LBN: 366Th Medgrp-Mountain Home
366Th Medgrp-Mountain Home is an health care organization with primary practice located at 90 Hope Drive Bldg 6000 366 Medical Group, Mountain Home Afb ID 83648-1062. The organization recently has 3 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient, Ambulatory Health Care Facilities / Military and U.S. Coast Guard Ambulatory Procedure, Suppliers / Military/U.S. Coast Guard Pharmacy. Ambulatory Health Care Facilities / Military and U.S. Coast Guard Ambulatory Procedure is the primary health care specialty. 366Th Medgrp-Mountain Home can be contacted via phone (208) 828-7470, or through Lewandowski, Jen via phone (703) 817-4030.

Contact Information

Primary practice address
90 Hope Drive Bldg 6000 366 Medical Group Mountain Home Afb ID 83648-1062
Phone: (208) 828-7470
Fax: (208) 828-2753
Website:
Map and Directions
Authorized official contact:
Name: Lewandowski, Jen
Phone: (703) 817-4030

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Military/U.S. Coast Guard Outpatient 261QM1100X
Ambulatory Health Care Facilities / Military and U.S. Coast Guard Ambulatory Procedure 261QM1101X
Suppliers / Military/U.S. Coast Guard Pharmacy 332000000X

Profile Details

NPI number 1063487791
LBN Legal business name 366Th Medgrp-Mountain Home
DBA Doing business as
Authorized official Lewandowski, Jen
Entity Organization
Organization subpart 1 Yes
Enumeration date Feb 17th, 2006
Last updated Jun 17th, 2025 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063487791 NPPES
Idaho MEDICAID 8072078
Idaho Other 1306845

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