Timothy Blake Wilder, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

310 W Losey St
Scott AFB, IL 62225-5250

Phone

(618) 256-8970

NPI assigned

May 7, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241654400000",
    "number": "1184858045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 CIRCLE DR",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622083303",
            "telephone_number": "618-394-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-8970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "TIMOTHY",
        "middle_name": "BLAKE",
        "credential": "IDMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-07",
        "last_updated": "2009-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Valerio, MD, MPH
• Robert Lloyd Van House, D.D.S.
• Natasha A Vaughn, PHARMACIST
• John Joseph Weatherwax, ARNP
• Kathleen Wein, RD, CDE, LD
• David Adam Williams, M.D.
• Dawn Wilson, PT
• David C Wright, PHD
• John M Yaccino, DDS
• Assy Yacoub, D.O.

• Independent Duty Medical Technicians in Scott AFB, IL
• Providers in Scott AFB, IL by specialty
• Independent Duty Medical Technicians in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.