OrganizationActive
366th Medgrp-Mountain Home
NPI 1063487791 · Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center · Mountain Home Afb, ID
Provider details
- NPI number
- 1063487791
- Entity type
- Organization
- Primary specialty
- Military and U.S. Coast Guard Ambulatory Procedure Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- 366th Medgrp-Mountain Home
- Authorized official
- Jen Lewandowski, Dha Ubo
Practice location
90 Hope Drive Bldg 6000
366 Medical Group
Mountain Home Afb, ID 83648-1062
Phone: (208) 828-7470
Fax: (208) 828-2753
Mailing address
90 Hope Drive Bldg 6000
Mountain Home Afb, ID 83648-1062
Registry dates
- Enumerated
- 2006-02-17
- Last updated
- 2025-06-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.