Samuel Wyatt Hensley, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

100 Cirrus CV
Cibolo, TX 78108

Phone

(210) 596-6938

NPI assigned

Aug 21, 2017

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": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503273600000",
    "number": "1710403761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CIRRUS CV",
            "city": "CIBOLO",
            "state": "TX",
            "postal_code": "781084250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CIRRUS CV",
            "city": "CIBOLO",
            "state": "TX",
            "postal_code": "78108",
            "telephone_number": "210-596-6938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENSLEY",
        "first_name": "SAMUEL",
        "middle_name": "WYATT",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-21",
        "last_updated": "2017-08-21",
        "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": []
}

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• Independent Duty Medical Technicians in Cibolo, TX
• Providers in Cibolo, TX by specialty
• Independent Duty Medical Technicians in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; 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.