17TH MEDGRP-GOODFELLOW
NPI 1104805142
Clinic/Center - Military/U.S. Coast Guard Outpatient in Goodfellow Afb, TX
NPI Status: Active since January 10, 2006
Contact Information
271 FORT RICHARDSON AVE
GOODFELLOW AFB, TX
ZIP 76908
Phone: (325) 654-5974
Fax: (325) 654-3121
- Organization
- Clinic/Center
- Military/U.S. Coast Guard Outpatient
About 17TH MEDGRP-GOODFELLOW
This page provides the complete NPI Profile along with additional information for 17th Medgrp-goodfellow, a provider established in Goodfellow Afb, Texas operating as a Clinic/center, focusing in military/u.s. coast guard outpatient . The healthcare provider is registered in the NPI registry with number 1104805142 assigned on January 2006. The practitioner's primary taxonomy code is 261QM1100X. The provider is registered as an organization and their NPI record was last updated June 2025. The authorized official of this NPI record is Jen Lewandowski (Dha Ubo)
- NPI
- 1104805142
- Provider Name
- 17TH MEDGRP-GOODFELLOW
- Entity Type
- Organization
- Location Address
- 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908
- Location Phone
- (325) 654-5974
- Location Fax
- (325) 654-3121
- Mailing Address
- 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908
- Mailing Phone
- (325) 654-5974
- Mailing Fax
- (325) 654-3121
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 01-10-2006
- Last Update Date
- 06-17-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Military/U.S. Coast Guard Outpatient
- Taxonomy Code
- 261QM1100X
- Type
- Ambulatory Health Care Facilities
- License State
- TX
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QM1101X | Ambulatory Health Care Facilities | Clinic/Center | |
| 2 | 332000000X | Suppliers | Military/U.S. Coast Guard Pharmacy |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 4596740 | OTHER (01) | TX | NCPDP |
Reviews for 17TH MEDGRP-GOODFELLOW
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 0 | 4 | 8 | 0 | 5 | 1 | 4 | 2 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 0 | 4 | 16 | 0 | 10 | 1 | 8 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 0 + 4 + 1 + 6 + 0 + 1 + 0 + 1 + 8 + 24 = 48 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 48 = 2 | 2 | ||||||||
The NPI number 1104805142 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1053400101 | MR. PAUL D SCHROTH FNP Individual | Nurse Practitioner (Family) | 271 FORT RICHARDSON AVE GOODFELLOW AFB CLINIC GOODFELLOW AIR FORCE BASE, TX 76908 (325) 654-3238 |
| 1053582676 | PEDRO COLON Individual | Pharmacist | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3101 |
| 1952574824 | MRS. TERESA MARIE STANLEY PA Individual | Physician Assistant (Medical) | 271 FORT RICHARDSON AVE BLDG 1001 GOODFELLOW AFB, TX 76908 (210) 845-9912 |
| 1235490574 | 17TH MEDICAL GROUP Organization | Clinic/Center (Health Service) | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-5238 |
| 1720278773 | LINDSAY ELISHA DENTON O.D. Individual | Optometrist | 271 FORT RICHARDSON AVE OPTOMETRY CLINIC GOODFELLOW AFB, TX 76908 (325) 654-3120 |
| 1588828974 | MISS ALICIA MARIE DUDLEY LICSW Individual | Social Worker (Clinical) | 271 FORT RICHARDSON AVE GOODFELLOW AFB SAN ANGELO, TX 76908 (325) 654-3122 |
| 1043688849 | AUBRIE WNEK PHARMD Individual | Pharmacist | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3101 |
| 1851486419 | WARREN DIAL PA Individual | Physician Assistant (Medical) | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-5989 |
| 1326576521 | ALEKSANDR GOLDEN MCPIKE IDMT Individual | Military Health Care Provider (Independent Duty Medical Technicians) | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-5343 |
| 1023534062 | MS. JENNIFER LYNN HOELSCHER RPH Individual | Pharmacist | 271 FORT RICHARDSON AVE SAN ANGELO, TX 76908 (325) 654-5773 |
| 1548779234 | STRAVENS MOSETI OMWENGA Individual | Nurse Practitioner | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3149 |
| 1235687799 | THOMAS MONTGOMERY DDS Individual | Dentist | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3050 |
| 1962778019 | NICOLE M CAMPBELL PHD Individual | Psychologist (Clinical) | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3122 |
| 1114350998 | MR. ROBERT WAYNE TURNER LCSW Individual | Social Worker (Clinical) | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-5796 |
| 1568859650 | DEVIN MERRITT PHD Individual | Psychologist | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3122 |
| 1497201925 | SAMANTHA SLIKKERS DDS Individual | Dentist | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3050 |
| 1952641664 | DR. JOSIAH BENJAMIN WARD D.O. Individual | Pediatrics | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3647 |
| 1659618338 | DR. MICHELLE SUZANNE RIVERA HANBY PH.D. Individual | Psychologist | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3122 |
| 1326545450 | MATTHEW THOMAS BEAN Individual | Dentist | 271 FORT RICHARDSON AVE GOODFELLOW AFB, TX 76908 (325) 654-3050 |
| 1255974044 | DR. CHARLES ZAPATA PHD Individual | Psychologist (Clinical) | 271 FORT RICHARDSON AVE SAN ANGELO, TX 76908 (325) 654-3122 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104805142, enumerated in the NPI registry as an "organization" on January 10, 2006
The provider is located at 271 Fort Richardson Ave Goodfellow Afb, Tx 76908 and the phone number is (325) 654-5974
This medical organization specializes in Clinic/Center with taxonomy code 261QM1100X with a focus in Military/U.S. Coast Guard Outpatient
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
This NPI record was last updated on January 10, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.