NPI age
20 years
Enumerated 2006-02-17
● Active Type 2 · Organization
Subpart
366th Medgrp-Mountain Home
366th Medgrp-Mountain Home is 1 of 1 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Plus 2 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Lewandowski
Dha Ubo
Last NPPES update
2025-06-17
Source: monthly bulk 2026-05
How this organization compares
Across 1 active clinic/center providers in Idaho.
NPI age
20 years
≈ at median (20 yr)
Practice locations
1
0 secondary on file
Subspecialties
2
In the 100% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-02Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
90 Hope Drive Bldg 6000, 366 Medical Group
Mountain Home Afb, ID 836481062
Mailing address
90 Hope Drive Bldg 6000, 366 Medical Group Sgsr
Mountain Home Afb, ID 836481062
Authorized official
Jen Lewandowski
Dha Ubo
📞 7038174030
Specialties
-
Clinic/Center PrimaryThat 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...
-
Clinic/CenterThe 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...
-
Military/U.S. Coast Guard PharmacyA Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 8072078 | |
| 01 (ID) | 1306845 | NCPDP |
Practice context
Single-site organization. Only one practice location on file.
Subpart of 366th Medgrp-Mountain Home.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.