Active NPI
Eric Landry Provo
- Independent Duty Corpsman
- Norfolk, VA
National Provider Identifier
1407815392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 8857 1St St Ste 400
Norfolk, VA 23511-3713 - Phone
- (757) 445-7256
- Fax
- (757) 576-4161
- NPI assigned
- Mar 21, 2006
- 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 |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
8857 1St St Ste 400
Norfolk, VA 23511-3713
Mailing address
8857 1St St Ste 400
Norfolk, VA 23511-3713
Phone (757) 445-7256
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710I1002X | Other | VA | INDEPENDENT DUTY CORPSMAN |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255478400000",
"number": "1407815392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8857 1ST ST STE 400",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235113713",
"telephone_number": "757-445-7256",
"fax_number": "757-576-4161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8857 1ST ST STE 400",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235113713",
"telephone_number": "757-445-7256",
"fax_number": "757-576-4161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVO",
"first_name": "ERIC",
"middle_name": "LANDRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-21",
"last_updated": "2009-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT DUTY CORPSMAN",
"identifier": "1710I1002X",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.