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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: July 19, 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

Reviews for 628TH MEDGRP-CHARLESTON

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Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

MRS. PATRICIA JOY FINKENBERG LCSW
Social Worker (Clinical)
204 W HILL BLVD, 437 MDOS/SGOH
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6972
KAREN BERKELEY PHARMD
Pharmacist
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6809
MR. ROBERT RAY BRYANT PA
Physician Assistant
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6790
DR. ANGELA R FITZPATRICK DDS
Dentist
204 W HILL BLVD, BLDG 364
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6879
UNITED STATES AIR FORCE
Clinic/Center
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6936
JENNIFER B CUTLIP IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6984
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
MS. PATRICIA L SILLS IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6733
MR. GEORGE JAMES ANTOLICK IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6743
MONTI CUTLIP JR. IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
204 W HILL BLVD
CHARLESTON, SC 29404
Charleston County (843) 963-6905
DR. MICHAEL STEVEN PHILLIPS D.M.D.
Dentist (General Practice)
204 W HILL BLVD, 628TH MEDICAL GROUP DENTAL SERVICES
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6822
DR. JERRY MARK FLETCHER RPH
Pharmacist
204 W HILL BLVD, 628 MEDICAL GROUP PHARMACY
JOINT BASE CHARLESTON, SC 29404
Charleston County (843) 963-6809
KATHERINE HAYES RAINEY DPT
Physical Therapist
204 W HILL BLVD, JOINT BASE CHARLESTON
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6791
BRETT RANDALL IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6880
BRANDON STOKER IDMT
Military Health Care Provider (Independent Duty Medical Technicians)
204 W HILL BLVD
CHARLESTON, SC 29404
Charleston County (843) 963-6808
THI NGUYEN
Pharmacist
204 W HILL BLVD, 628TH MEDICAL GROUP
CHARLESTON AFB, SC 29404
Charleston County (843) 963-6808
MRS. JANICE M. WILLIAMS MSW
Social Worker (Clinical)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Charleston County (843) 577-5011
JENNIFER S. GREEN SOCIAL WORKER
Social Worker (Clinical)
204 W HILL BLVD
CHARLESTON, SC 29404
Charleston County (843) 963-6971
CALVIN JON BOSMAN M.D.
Psychiatry & Neurology (Psychiatry)
204 W HILL BLVD
CHARLESTON, SC 29404
Charleston County (843) 963-6852
DR. MATTHEW BURNS D.M.D.
Dentist
204 W HILL BLVD
JOINT BASE CHARLESTON, SC 29404
Charleston County (843) 963-6864

Frequently Asked Questions

What is 628TH MEDGRP-CHARLESTON's NPI number?

The NPI number assigned to this healthcare provider is 1114905775, enumerated as an "organization" on January 04, 2006.

Where is the provider located?

The provider is located at 204 W HILL BLVD BLDG 364 CHARLESTON AFB, SC 29404 and the phone number is (843) 963-6884.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QM1100X and a focus in Military/U.S. Coast Guard Outpatient.

What insurance does 628TH MEDGRP-CHARLESTON accept?

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.