Active NPI
Paul Erik Kerckhoff, AIR FORCE IDMT
- Other Technician
- Fairchild Afb, WA
National Provider Identifier
1790919777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- B0441656
- Practice address
- 701 Hospital Loop
Fairchild Afb, WA 99011-8704 - Phone
- (509) 247-5755
- Fax
- (509) 247-8833
- NPI assigned
- May 6, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | B0441656 | AZ | Primary |
Addresses
Primary practice location
701 Hospital Loop
Fairchild Afb, WA 99011-8704
Mailing address
5998 Kamiakin TRL
Fairchild Afb, WA 99011-2210
Phone (509) 290-6206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B0441656 | AZ | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241568000000",
"number": "1790919777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5998 KAMIAKIN TRL",
"city": "FAIRCHILD AFB",
"state": "WA",
"postal_code": "990112210",
"telephone_number": "509-290-6206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 HOSPITAL LOOP",
"city": "FAIRCHILD AFB",
"state": "WA",
"postal_code": "990118704",
"telephone_number": "509-247-5755",
"fax_number": "509-247-8833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERCKHOFF",
"first_name": "PAUL",
"middle_name": "ERIK",
"name_prefix": "Mr.",
"credential": "AIR FORCE IDMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-05-06",
"last_updated": "2009-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "AZ",
"license": "B0441656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairchild Afb, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.