Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

366th Medgrp-Mountain Home

Organization Military/U.S. Coast Guard Outpatient Clinic/Center · NPI 1063487791

366th Medgrp-Mountain Home is a Military/U.S. Coast Guard Outpatient Clinic/Center in Mountain Home AFB, Idaho. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
3
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Practice location Address checks out

90 Hope Dr Bldg 6000 366 Medical Group
Mountain Home AFB, ID 83648-1062
Phone: (208) 828-7470
Fax: (208) 828-2753
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center (primary) Taxonomy 261QM1101X
Military/U.S. Coast Guard Outpatient Clinic/Center Taxonomy 261QM1100X
Military/U.S. Coast Guard Pharmacy Taxonomy 332000000X

Record details

NPI number1063487791
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organization366th Medgrp-Mountain Home
Authorized official Jen Lewandowski — Dha Ubo · (703) 817-4030
NPI enumeratedFebruary 17, 2006
Last updated in NPPESJune 17, 2025
Certification dateJune 17, 2025
Mailing address90 Hope Drive Bldg 6000, 366 Medical Group Sgsr, Mountain Home Afb, ID 83648-1062