NPIMap

Individual provider Active NPI

Michael Douglas Bradley, ADVANCED EMT

  • Basic Emergency Medical Technician
  • Fort Rucker, AL
National Provider Identifier
1972771293
Registry record updated Apr 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Basic Emergency Medical TechnicianTaxonomy code 146N00000X
License
E0298474 Issued in AL
Practice address
BLD 301 Andrews Ave
Lyster Army Health Clinic
Ft. Rucker, AL 36362
Phone
(334) 255-7799
NPI assigned
Feb 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Basic Emergency Medical Technician 146N00000X E0298474 AL Primary
Intermediate Emergency Medical Technician 146M00000X 8834260 AL

Addresses

Primary practice location

BLD 301 Andrews Ave
Lyster Army Health Clinic
Ft. Rucker, AL 36362

Mailing address

BLD 301 Andrews Ave
Lyster Army Health Clinic
Ft. Rucker, AL 36362
Phone (334) 255-7799

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
Credentials
Emergency Medical Technician

State licenses

LicenseStateTypeSpecialty
8834260ALMDIntermediate Emergency Medical Technician
E0298474ALMDBasic Emergency Medical Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428969600000",
    "number": "1972771293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLD 301 ANDREWS AVE",
            "address_2": "LYSTER ARMY HEALTH CLINIC",
            "city": "FT. RUCKER",
            "state": "AL",
            "postal_code": "36362",
            "telephone_number": "334-255-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLD 301 ANDREWS AVE",
            "address_2": "LYSTER ARMY HEALTH CLINIC",
            "city": "FT. RUCKER",
            "state": "AL",
            "postal_code": "36362",
            "telephone_number": "334-255-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MICHAEL",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "ADVANCED EMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-20",
        "last_updated": "2015-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "AL",
            "license": "E0298474",
            "primary": true
        },
        {
            "code": "146M00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Intermediate",
            "state": "AL",
            "license": "8834260",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Rucker, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; 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.