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366TH MEDGRP-MOUNTAIN HOME
NPI 1063487791
Clinic/Center - Military and U.S. Coast Guard Ambulatory Procedure in Mountain Home Afb, ID

Active since February 17, 2006
90 HOPE DRIVE BLDG 6000, 366 MEDICAL GROUP, MOUNTAIN HOME AFB, ID 83648(208) 828-7470(208) 828-2753 Get Directions Write a Review

NPPES record last updated: June 17, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 17, 2025, Jun 12, 2025, Nov 8, 2017 (3 updates tracked since 2017).

About 366th Medgrp-mountain Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

366TH MEDGRP-MOUNTAIN HOME (NPI 1063487791) is a healthcare organization registered as a military and u.s. coast guard ambulatory procedure in Mountain Home Afb, Idaho and active in the NPI registry since February 2006. The organization lists Jen Lewandowski, Dha Ubo, as its authorized official.

NPPES Registry Identity

NPI1063487791
Entity TypeOrganization
Primary Taxonomy261QM1101X
Legal Business Name366TH MEDGRP-MOUNTAIN HOME
Location Address90 HOPE DRIVE BLDG 6000, 366 MEDICAL GROUPMountain Home Afb, ID 83648-1062
Mailing Address90 Hope Drive Bldg 6000, 366 Medical Group SgsrMountain Home Afb, ID 83648-1062 · (208) 828-7470 · Fax (208) 828-2753
Phone(208) 828-7470
Fax(208) 828-2753
Organization SubpartYes
Authorized OfficialJen LewandowskiDha Ubo · (703) 817-4030
Enumeration DateFebruary 17, 2006
Last NPPES UpdateJune 17, 20253 updates tracked since enumeration
NPPES CertifiedJune 17, 2025
✔ NPI 1063487791 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Military and U.S. Coast Guard Ambulatory ProcedureAmbulatory Health Care Facilities
Taxonomy Code261QM1101X
Definition
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.
Also ListedClinic/Center · Military/U.S. Coast Guard OutpatientTaxonomy 261QM1100X
Also ListedMilitary/U.S. Coast Guard PharmacyTaxonomy 332000000X
90 HOPE DRIVE BLDG 6000, Mountain Home Afb, ID 83648
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Other Identifiers 2

Medicaid8072078ID
Other1306845ID · Ncpdp

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DANDY RAE AARON IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
90 HOPE DRIVE BLDG 6000
MOUNTAIN HOME, ID 83648
Elmore County (208) 828-7313
MISS KATHLEEN L LACASSE IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
90 HOPE DRIVE BLDG 6000
MOUNTIAN HOME AFB, ID 83648
Elmore County (208) 828-7401

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is 366th Medgrp-Mountain Home's NPI number?

The NPI number for 366th Medgrp-Mountain Home is 1063487791. It was assigned to this organization in the NPPES registry on February 17, 2006.

Where is 366th Medgrp-Mountain Home located?

366th Medgrp-Mountain Home is located at 90 Hope Drive Bldg 6000 366 Medical Group, Mountain Home Afb, ID 83648. The listed phone number is (208) 828-7470.

What is 366th Medgrp-Mountain Home's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Military and U.S. Coast Guard Ambulatory Procedure, with taxonomy code 261QM1101X.

When was this NPI record last updated?

The NPPES record for 366th Medgrp-Mountain Home was last updated on June 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.