59TH MDW-WHASC-LACKLAND NPI 1275511776

NPI Information

NPI: 1275511776
Provider Name: 59TH MDW-WHASC-LACKLAND
Classification: Clinic/Center - 261QM1101X
Specialization: Military and U.S. Coast Guard Ambulatory Procedure
Entity Type: Organization
:
Address: 2200 BERGQUIST DR
SUITE 1 ADBS
LACKLAND A F B, TX
ZIP 78236
Phone: (210) 292-7575

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NPI Details

59TH MDW-WHASC-LACKLAND is a military and u.s. coast guard ambulatory procedure clinic center in Lackland A F B, TX. The provider is that part of a fixed (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery. Similar to a civilian ambulatory surgical center. May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial take home pharmaceuticals. 59TH MDW-WHASC-LACKLAND NPI is 1275511776. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

2200 BERGQUIST DR
SUITE 1 ADBS
LACKLAND A F B, TX
ZIP 78236-907
Phone: (210) 292-7575
Fax: (210) 292-2592

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 1/4/2006 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	Primary
1	261QM1100X	Clinic/Center	Military/U.S. Coast Guard Outpatient	No
2	332000000X	Military/U.S. Coast Guard Pharmacy		No
3	261QM1101X	Clinic/Center	Military and U.S. Coast Guard Ambulatory Procedure	Yes

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
1	HH6032	OTHER	TEXAS	BLUE CROSS BLUE SHIELD
2	4596776	OTHER	TEXAS	NCPDP
3	021757201	MEDICAID	TEXAS

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: 3/30/2025

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