Provider Demographics
NPI:1992061790
Name:39TH MEDGRP-INCIRLIK
Entity type:Organization
Organization Name:39TH MEDGRP-INCIRLIK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DHA FINANCIAL
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:UNIT 7095, BOX 185
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-5185
Mailing Address - Country:US
Mailing Address - Phone:0119032-316-8764
Mailing Address - Fax:
Practice Address - Street 1:UNIT 7095 BOX 185
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824-7095
Practice Address - Country:US
Practice Address - Phone:01190322-316-8794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:39TH MEDGRP-INCIRLIK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-05
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1102XAmbulatory Health Care FacilitiesClinic/CenterMilitary Outpatient Operational (Transportable) Component
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography