John La Cruz, IDMT
Individual provider Active NPI Independent Duty Medical Technicians · McConnell Afb, KS
NPI 1760616015 · NPPES record last updated May 14, 2009
Key facts
- NPI
- 1760616015
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Medical Technicians 1710I1003X
- Practice address
- 22 MDG
McConnell Afb, KS 67221-3712 - Phone
- (316) 759-5116
- NPI assigned
- May 14, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Medical Technicians | 1710I1003X | Yes |
Addresses
Primary practice location
22 MDG
McConnell Afb, KS 67221-3712
Mailing address
22 MDG
McConnell Afb, KS 67221-3712
Phone (316) 759-5116
Other providers in McConnell Afb, KS
- Larry E Chupp
- Dawn Marie Clifton
- Tyler Paul Cody
- Caroline B Coffey
- Max Austin Crabtree
- Matthew Scott Davis
- Alicia Rae Delvaux
- Jason Deselms
- Nenita S Diego
- Cari Ann Dimercurio
All providers in McConnell Afb, KS · Independent Duty Medical Technicians in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.