97TH MEDGRP-ALTUS NPI 1093782880

NPI Information

  • NPI: 1093782880
  • Provider Name: 97TH MEDGRP-ALTUS
  • Classification: Clinic/Center - 261QM1100X
  • Specialization: Military/U.S. Coast Guard Outpatient
  • Entity Type: Organization
  • Address: 301 N 1ST ST
    BLDG 46
    ALTUS AFB, OK
    ZIP 73523
  • Phone: (580) 481-5400

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NPI Details

97TH MEDGRP-ALTUS is a military/u.s. coast guard outpatient clinic center in Altus Afb, OK. The provider is 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. 97TH MEDGRP-ALTUS NPI is 1093782880. The provider is registered as an organization entity type.

The provider's business location address is:

301 N 1ST ST
BLDG 46
ALTUS AFB, OK
ZIP 73523-004
Phone: (580) 481-5400
Fax: (580) 481-5416

The provider's authorized official is Jen Lewandowski .
The authorized official title is Dha Ubo and has the following contact phone number (703) 817-4030.

The enumeration date for this NPI number is 3/1/2006 and was last updated on 6/17/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM1100XClinic/CenterMilitary/U.S. Coast Guard OutpatientYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13720225OTHEROKLAHOMANCPDP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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