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17TH MEDGRP-GOODFELLOW
NPI 1104805142
Clinic/Center - Military/U.S. Coast Guard Outpatient in Goodfellow Afb, TX

Active since January 10, 2006
271 FORT RICHARDSON AVE, GOODFELLOW AFB, TX 76908(325) 654-5974(325) 654-3121 Get Directions Write a Review

NPPES record last updated: June 17, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 17, 2025, Jun 12, 2025 (2 updates tracked since 2025).

About 17th Medgrp-goodfellow NPPES

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

17TH MEDGRP-GOODFELLOW (NPI 1104805142) is a healthcare organization registered as a military/u.s. coast guard outpatient in Goodfellow Afb, Texas and active in the NPI registry since January 2006. The organization lists Jen Lewandowski, Dha Ubo, as its authorized official.

NPPES Registry Identity

NPI1104805142
Entity TypeOrganization
Primary Taxonomy261QM1100X
Legal Business Name17TH MEDGRP-GOODFELLOW
Location Address271 FORT RICHARDSON AVEGoodfellow Afb, TX 76908-4901
Mailing Address271 Fort Richardson AveGoodfellow Afb, TX 76908-4901 · (325) 654-5974 · Fax (325) 654-3121
Phone(325) 654-5974
Fax(325) 654-3121
Organization SubpartYes
Authorized OfficialJen LewandowskiDha Ubo · (703) 817-4030
Enumeration DateJanuary 10, 2006
Last NPPES UpdateJune 17, 20252 updates tracked since enumeration
NPPES CertifiedJune 17, 2025
✔ NPI 1104805142 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Military/U.S. Coast Guard OutpatientAmbulatory Health Care Facilities
Taxonomy Code261QM1100X
Definition

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.

Also ListedClinic/Center · Military and U.S. Coast Guard Ambulatory ProcedureTaxonomy 261QM1101X
Also ListedMilitary/U.S. Coast Guard PharmacyTaxonomy 332000000X
271 FORT RICHARDSON AVE, Goodfellow Afb, TX 76908
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Other Identifiers 1

Other4596740TX · Ncpdp

Other Providers at the Same Location NPPES 20

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

MS. JENNIFER LYNN HOELSCHER RPH
Pharmacist
271 FORT RICHARDSON AVE
SAN ANGELO, TX 76908
Tom Green County (325) 654-5773
TRENT WEYER
Dentist
271 FORT RICHARDSON AVE
SAN ANGELO, TX 76908
Tom Green County (325) 654-3050
AUBRIE WNEK PHARMD
Pharmacist
271 FORT RICHARDSON AVE
GOODFELLOW AFB, TX 76908
Tom Green County (325) 654-3101
MR. PAUL D SCHROTH FNP
Nurse Practitioner (Family)
271 FORT RICHARDSON AVE, GOODFELLOW AFB CLINIC
GOODFELLOW AIR FORCE BASE, TX 76908
Tom Green County (325) 654-3238
PEDRO COLON
Pharmacist
271 FORT RICHARDSON AVE
GOODFELLOW AFB, TX 76908
Tom Green County (325) 654-3101
MIN DAVISON LCSW
Social Worker (Clinical)
271 FORT RICHARDSON AVE
SAN ANGELO, TX 76908
Tom Green County (325) 654-1600
MR. ROBERT WAYNE TURNER LCSW
Social Worker (Clinical)
271 FORT RICHARDSON AVE
GOODFELLOW AFB, TX 76908
Tom Green County (325) 654-5796
MR. MICHAEL ROY DE JESUS DNP, APRN, FNP-C
Nurse Practitioner (Family)
271 FORT RICHARDSON AVE
GOODFELLOW AFB, TX 76908
Tom Green County (325) 654-3149

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 17th Medgrp-Goodfellow's NPI number?

The NPI number for 17th Medgrp-Goodfellow is 1104805142. It was assigned to this organization in the NPPES registry on January 10, 2006.

Where is 17th Medgrp-Goodfellow located?

17th Medgrp-Goodfellow is located at 271 Fort Richardson Ave, Goodfellow Afb, TX 76908. The listed phone number is (325) 654-5974.

What is 17th Medgrp-Goodfellow's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Military/U.S. Coast Guard Outpatient, with taxonomy code 261QM1100X.

When was this NPI record last updated?

The NPPES record for 17th Medgrp-Goodfellow was last updated on June 17, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.