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628TH MEDGRP-CHARLESTON
NPI 1114905775
Clinic/Center - Military/U.S. Coast Guard Outpatient in Charleston Afb, SC

Active since January 04, 2006
204 W HILL BLVD, BLDG 364, CHARLESTON AFB, SC 29404(843) 963-6884(843) 963-6538 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, May 30, 2025 (2 updates tracked since 2025).

About 628th Medgrp-charleston NPPES

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

628TH MEDGRP-CHARLESTON (NPI 1114905775) is a healthcare organization registered as a military/u.s. coast guard outpatient in Charleston Afb, South Carolina and active in the NPI registry since January 2006. The organization lists Jen Lewandowski, Dha Ubo, as its authorized official.

NPPES Registry Identity

NPI1114905775
Entity TypeOrganization
Primary Taxonomy261QM1100X
Legal Business Name628TH MEDGRP-CHARLESTON
Location Address204 W HILL BLVD, BLDG 364Charleston Afb, SC 29404-4704
Mailing Address204 W Hill Blvd, Bldg 364Charleston Afb, SC 29404-4704 · (843) 963-6884 · Fax (843) 963-6538
Phone(843) 963-6884
Fax(843) 963-6538
Organization SubpartYes
Authorized OfficialJen LewandowskiDha Ubo · (703) 817-4030
Enumeration DateJanuary 4, 2006
Last NPPES UpdateJune 17, 20252 updates tracked since enumeration
NPPES CertifiedJune 17, 2025
✔ NPI 1114905775 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
204 W HILL BLVD, Charleston Afb, SC 29404
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Other Identifiers 1

Other42-22181SC · 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.

UNITED STATES AIR FORCE
Clinic/Center
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6936
MR. CHAD ROBERT WILLIAMS LCSW
Social Worker (Clinical)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6852
DR. CHANTELL RENEE MCKEE M.D.
Family Medicine
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6880
THI NGUYEN
Pharmacist
204 W HILL BLVD, 628TH MEDICAL GROUP
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6808
RONNIE LEE GODBOLT IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6936
VIRGINIA BULLEMAN LISW-CP
Social Worker (Clinical)
204 W HILL BLVD
JOINT BASE CHARLESTON, SC 29404
Charleston County (843) 963-6880
SARA T HANSEN LISW-CP
Social Worker (Clinical)
204 W HILL BLVD
JOINT BASE CHARLESTON, SC 29404
Charleston County (843) 963-6880
DR. OSCAR ALEJANDRO LEYVA CAMACHO MD
Preventive Medicine (Aerospace Medicine)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6722

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 628th Medgrp-Charleston's NPI number?

The NPI number for 628th Medgrp-Charleston is 1114905775. It was assigned to this organization in the NPPES registry on January 4, 2006.

Where is 628th Medgrp-Charleston located?

628th Medgrp-Charleston is located at 204 W Hill Blvd Bldg 364, Charleston Afb, SC 29404. The listed phone number is (843) 963-6884.

What is 628th Medgrp-Charleston'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 628th Medgrp-Charleston 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.