Michael C Etheredge II, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

77 Nealy Ave
Langley Afb, VA 23665-2040

Phone

(757) 764-6800

NPI assigned

Sep 17, 2019

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": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1639729106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 NEALY AVE",
            "city": "LANGLEY AFB",
            "state": "VA",
            "postal_code": "236652040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 NEALY AVE",
            "city": "LANGLEY AFB",
            "state": "VA",
            "postal_code": "236652040",
            "telephone_number": "757-764-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHEREDGE",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "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": []
}

• Victor De Leon, IDMT
• Jonathan Henry Desimone, DO
• Denise Michelle Dunklee, NURSE PRACTITIONER
• Joseph Mitchell Duren Jr., M.D.
• Michael Caleb English, D.M.D.
• Tonya Rayne Everleth, PHARM D
• Kevin Ryan Feiszli, PHD
• Jennifer E Fields, DO
• Laura Fike, EP-C
• Kristopher J. Filak, M.D.

• Independent Duty Medical Technicians in Langley Afb, VA
• Providers in Langley Afb, VA by specialty
• Independent Duty Medical Technicians in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; 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.