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377TH MEDGRP-KIRTLAND
NPI 1912982810
Clinic/Center - Military/U.S. Coast Guard Outpatient in Kirtland Afb, NM

Active since December 13, 2005
2050A SECOND ST SE, KIRTLAND AFB, NM 87117(505) 846-3605(505) 846-3594 Get Directions Write a Review

NPPES record last updated: June 17, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 17, 2025, Jun 12, 2025, Apr 1, 2024 (3 updates tracked since 2024).

About 377th Medgrp-kirtland NPPES

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

377TH MEDGRP-KIRTLAND (NPI 1912982810) is a healthcare organization registered as a military/u.s. coast guard outpatient in Kirtland Afb, New Mexico and active in the NPI registry since December 2005. The organization lists Jen Lewandowski, Dha Ubo, as its authorized official.

NPPES Registry Identity

NPI1912982810
Entity TypeOrganization
Primary Taxonomy261QM1100X
Legal Business Name377TH MEDGRP-KIRTLAND
Location Address2050A SECOND ST SEKirtland Afb, NM 87117-5524
Mailing Address2050a Second St SeKirtland Afb, NM 87117-5524 · (505) 846-3605 · Fax (505) 846-3594
Phone(505) 846-3605
Fax(505) 846-3594
Organization SubpartYes
Authorized OfficialJen LewandowskiDha Ubo · (703) 817-4030
Enumeration DateDecember 13, 2005
Last NPPES UpdateJune 17, 20253 updates tracked since enumeration
NPPES CertifiedJune 17, 2025
✔ NPI 1912982810 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
2050A SECOND ST SE, Kirtland Afb, NM 87117
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Other Identifiers 1

Other32-08926NM · 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.

DR. STEPHEN ANTONIOLI JENNINGS M.D.
Surgery
2050A SECOND ST SE
KIRTLAND AFB, NM 87117
Bernalillo County (505) 846-2426
BROOKE TAYLOR PHARMD
Pharmacist
2050A SECOND ST SE
KIRTLAND AFB, NM 87117
Bernalillo County (505) 846-3131

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 377th Medgrp-Kirtland's NPI number?

The NPI number for 377th Medgrp-Kirtland is 1912982810. It was assigned to this organization in the NPPES registry on December 13, 2005.

Where is 377th Medgrp-Kirtland located?

377th Medgrp-Kirtland is located at 2050A Second St SE, Kirtland Afb, NM 87117. The listed phone number is (505) 846-3605.

What is 377th Medgrp-Kirtland'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 377th Medgrp-Kirtland 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 14 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.