Active NPI
Selmman Ricardo Padridin
- Medical Laboratory Technician
- Fort Stewart, GA
National Provider Identifier
1124420377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Laboratory Technician
- License
- 25468079
- Practice address
- 411 E 9TH St
Box #12
Fort Stewart, GA 31314-5036 - Phone
- (912) 435-6081
- NPI assigned
- Sep 18, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Laboratory Technician | 246RM2200X | 25468079 | TX | Primary |
Addresses
Primary practice location
411 E 9TH St
Box #12
Fort Stewart, GA 31314-5036
Mailing address
1283 SE 7TH CT
Deerfield Beach, FL 33441-5868
Phone (754) 214-9122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25468079 | TX | MD | Medical Laboratory Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410998400000",
"number": "1124420377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1283 SE 7TH CT",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334415868",
"telephone_number": "754-214-9122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 E 9TH ST",
"address_2": "BOX #12",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "313145036",
"telephone_number": "912-435-6081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PADRIDIN",
"first_name": "SELMMAN",
"middle_name": "RICARDO",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-18",
"last_updated": "2014-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "246RM2200X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Medical Laboratory",
"state": "TX",
"license": "25468079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.