17th Medgrp-Goodfellow
17th Medgrp-Goodfellow is a healthcare organization registered as Military/U.S. Coast Guard Outpatient Clinic/Center in Goodfellow Afb, TX, holding Type 2 (organization) NPI 1104805142 since 2006. The authorized official on file is Jen Lewandowski, Dha Ubo.
✓ Active NPI ✓ Valid NPI checksum Organization subpart
| NPI | 1104805142 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | 17th Medgrp-Goodfellow |
| Parent organization | 17th Medgrp-Goodfellow |
| Practice address | 271 FORT RICHARDSON AVE, Goodfellow Afb, TX, 76908 |
| Phone | 3256545974 |
| Fax | 3256543121 |
| Enumeration date | 2006-01-10 |
| Last updated in NPPES | 2025-06-17 |
Authorized official
| Name | Jen Lewandowski |
|---|---|
| Title | Dha Ubo |
| Phone | 7038174030 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 261QM1101X | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center | Secondary | — | — |
| 332000000X | Military/U.S. Coast Guard Pharmacy | Secondary | — | — |
| 261QM1100X | Military/U.S. Coast Guard Outpatient Clinic/Center | Primary | — | TX |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4596740 | Other | TX | NCPDP |
Copy-ready billing details
Provider: 17th Medgrp-Goodfellow NPI: 1104805142 Taxonomy: 261QM1100X (Military/U.S. Coast Guard Outpatient Clinic/Center) Address: 271 FORT RICHARDSON AVE, Goodfellow Afb, TX, 76908
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1447621727 | Joel Martinez | Individual | Clinical Social Worker | San Angelo, TX |
| 1851486419 | Warren Dial | Individual | Medical Physician Assistant | Goodfellow Afb, TX |
| 1053400101 | Paul Schroth | Individual | Family Nurse Practitioner | Goodfellow Air Force Base, TX |
| 1720278773 | Lindsay Denton | Individual | Optometrist | Goodfellow Afb, TX |
Verify this record
Cross-check NPI 1104805142 against the authoritative CMS record: view 17th Medgrp-Goodfellow on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is 17th Medgrp-Goodfellow?
Source: CMS NPPES (public data). Snapshot 2026-07-09. Provider record last updated 2025-06-17.