NPIMap

Organization Active NPI

U.S. Navy

  • Independent Duty Corpsman
  • Groton, CT
National Provider Identifier
1477564870
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Independent Duty CorpsmanTaxonomy code 1710I1002X
Legal business name
U.S. NAVY
Practice address
Box 159 Navsubasenlon
Naval Undersea Medical Institute
Groton, CT 06340-5159
Phone
(860) 694-2876
Fax
(860) 694-3696
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Edward Theodore Miller, IDC
Title
Independent Duty Corpsman
Phone
(860) 634-2876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Duty CorpsmanGroup: 193400000X SINGLE SPECIALTY GROUP 1710I1002X Primary

Addresses

Primary practice location

Box 159 Navsubasenlon
Naval Undersea Medical Institute
Groton, CT 06340-5159

Mailing address

PO Box 159
Box 159 Navsubasenlon
Groton, CT 06340-5159
Phone (860) 694-2876

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477564870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "address_2": "BOX 159 NAVSUBASENLON",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063405159",
            "telephone_number": "860-694-2876",
            "fax_number": "860-694-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BOX 159 NAVSUBASENLON",
            "address_2": "NAVAL UNDERSEA MEDICAL INSTITUTE",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063405159",
            "telephone_number": "860-694-2876",
            "fax_number": "860-694-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "U.S. NAVY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "INDEPENDENT DUTY CORPSMAN",
        "authorized_official_telephone_number": "860-634-2876",
        "authorized_official_credential": "IDC"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Groton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.