Eric Black, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

431 Meadowlark St
Shaw Afb, SC 29152-5019

Phone

(803) 895-2273

NPI assigned

Oct 27, 2021

Sex

Male

Sole proprietor

No

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": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1558025429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 MEADOWLARK ST",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525019",
            "telephone_number": "803-895-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 MEADOWLARK ST",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525019",
            "telephone_number": "803-895-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "ERIC",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "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": []
}

• Leah Michelle Bagley, NP-C
• Jeffrey Allan Banks, M.D.
• John Alan Barnett, RPH
• Suzan Beattie
• Misty Marie Bennett, DDS
• Daniel Anthony Blaz, FNP-BC
• Elizabeth Ann Bowman, DDS
• Crystal Marie Boyle, LCSW
• Kyra Brooks, FNP-C
• Patti E Busser

• All providers in Shaw Afb, SC
• Independent Duty Medical Technicians in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; 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.