MR. LARIN TIMOTHY CLARK


Address: 101 Bodin Cir, Travis Afb, CA 94535-1809
Phone: 7074233727

MR. LARIN TIMOTHY CLARK (NPI# 1245792332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1245792332
Entity Type Individual
Full Name MR. LARIN TIMOTHY CLARK
Credential IDMT
Practice Address 101 Bodin Cir
Travis Afb
CA 94535-1809
Practice Telephone 7074233727
Mailing Telephone 7074233727
Enumeration Date 2019-04-05
Last Update Date 2019-04-05
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1710I1003X Military Health Care Provider
Specialization: Independent Duty Medical Technicians
Other Service Providers

Office Location

Street Address 101 BODIN CIR
City TRAVIS AFB
State CA
Zip Code 94535-1809

Providers in the same location

NPI Name Taxonomy Address Enumeration
1801893276 Charles A Tujo Radiology 101 Bodin Cir, Travis Afb, CA 94535-1809 2005-06-30
1538769351 Chelsey Violet Pelkey Military Health Care Provider 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-10-30
1538768114 Jordan Rose Student in an Organized Health Care Education/Training Program 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-10-23
1821606591 Madelyn Hale Military Health Care Provider 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-07-20
1932727856 Julie Thein Audiologist 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-07-07
1063039501 Shae Daniel Bryant Dentist 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-07-01
1598381089 Aaron J Surbaugh Student in an Organized Health Care Education/Training Program 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-06-19
1194348466 Amanda Vance Registered Nurse 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-05-21
1427681196 Bradley Burkey Student in an Organized Health Care Education/Training Program 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-02-20
1821629288 Gloria Calvillo Student in an Organized Health Care Education/Training Program 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-02-03
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1508487711 Sheila C Flood Student in an Organized Health Care Education/Training Program 101 Biden Circle, Fairfield, CA 94535 2020-04-28
1568081255 Miguel Julian Moreno Student in an Organized Health Care Education/Training Program 690 Airmen Drive, Travis Afb, CA 94535 2020-04-13
1174096101 Zlatoslava Karga Nurse Practitioner 60mdg / Sgow, 101 Bodin Circle, Travis Afb, CA 94535 2019-01-02
1437648292 Luke C Vera Dentist David Grant Medical Center 101 Bodin Circle, Travis Air Force Base, CA 94535 2018-05-08
1588163430 Sanaz Ziad Pharmacist 60mdg/mdts, 101 Bodin Circle, Travis Afb, CA 94535 2018-02-06
1194265686 Geoffrey Johnston Dentist 60 Mdg/sgdd, 101 Bodin Circle, Travis Afb, CA 94535 2017-03-02
1336693407 Hannah Isla Nordwall Social Worker 60 Mdg/mdos 101 Bodin Cir, Travis Afb, CA 94535 2016-08-06
1184177149 Taylor Murrie-robinson Social Worker 60mdg / Sgow Mental Health Clinic, 101 Bodin Circle, Travis Afb, CA 94535 2016-07-26
1952759607 Eric Kincaid-sharp General Practice 60 Mdg/amds, 101 Bodin Cir, Travis Afb, CA 94535 2016-06-02
1023472040 Genieve Marie Martinez-hernandez Internal Medicine 60 Mdg/sgomi, 101 Bodin Circle, Fairfield, CA 94535 2016-04-06
Find all providers in zip 94535

Taxonomy Information

Taxonomy Code 1710I1003X
Grouping Other Service Providers
Classification Military Health Care Provider
Specialization Independent Duty Medical Technicians

Taxonomy Definition

An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians.
Notes: Source: Air Force Surgeon General Office [7/1/2005: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1598182214 Matthew Wheaton Burns Military Health Care Provider 105 Colorado St, Travis Afb, CA 94535-1255 2014-03-19
1760740484 Rebecca Lee Flores Military Health Care Provider 60mdg/60 Mdos, 101 Bodin Circle, Travis Afb, CA 94535-1800 2012-05-01
1750648879 Dwinese Marise Aird Military Health Care Provider 113 Colorado Street, Travis Afb, CA 94535 2012-04-13
1477861474 Bernard Pillagara Bueno Military Health Care Provider 137 Maine Street, Travis Afb, CA 94535 2010-09-24
1366775355 Douglas Dwight Caldwell II Military Health Care Provider 150 Fitzgerald Dr, Travis Afb, CA 94535-1205 2009-09-09
1255566915 Keith John Barton Military Health Care Provider 531 Waldron St Ste D, 349th Aerospace Medicine Sqadron, Travis Afb, CA 94535-2125 2009-05-26
1538769351 Chelsey Violet Pelkey Military Health Care Provider 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-10-30
1821606591 Madelyn Hale Military Health Care Provider 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-07-20
1649810458 Andrew Lawrence Pierson Military Health Care Provider 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-01-09
1508406596 Ivette Mariana Brueggemann Military Health Care Provider 101 Bodin Cir, Travis Afb, CA 94535-1809 2020-01-08
Find all providers in TRAVIS AFB

Competitor

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City TRAVIS AFB
Zip Code 94535

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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