ANTHONY CHRISTOPHER DERRICO (NPI# 1538516471) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538516471 |
| Entity Type | Individual |
| Full Name | ANTHONY CHRISTOPHER DERRICO |
| Credential | D.O. |
| Practice Address |
366 Gunfighter Ave Ste 498 Mountain Home Afb ID 83648-5258 |
| Mailing Address |
5934 Wakefield Dr Sylvania OH 43560-3649 |
| Practice Telephone | 4192513232 |
| Mailing Telephone | 9544783514 |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2020-08-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
TL-4136 | ID | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609270669 | Anthony Derrico Sr. | Physical Therapy Assistant | 20 Summit Street, Cohoes, NY 12047 | 2014-10-20 |
| 1609886993 | Anthony R Derrico | Psychiatry & Neurology | 100 Hospital Dr, Athens, OH 45701-2301 | 2006-08-09 |
| Street Address |
366 GUNFIGHTER AVE STE 498 |
| City | MOUNTAIN HOME AFB |
| State | ID |
| Zip Code | 83648-5258 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851528392 | Amy Jo Glover | Military Health Care Provider | 90 Hope Dr. Bldg 6000, Mountain Home, ID 83648 | 2009-06-11 |
| 1306051065 | Thomas Michael Smith | Social Worker | 90 Hope Dr Bldg 1900, Mountain Home Afb, ID 83648 | 2007-05-14 |
| 1316005143 | Ronald Wesley Bailey | Radiology | Mountain Home Afb Medical Group, 90 Hope Drive, Building 6000, Mountain Home Afb, ID 83648 | 2006-12-05 |
| 1992780597 | Randall Jay Moore | Preventive Medicine | 366mdg/sgpf, 90 Hope Drive; Bldg 6000, Mountain Home Afb, ID 83648 | 2005-12-07 |
| 1356325666 | Joseph Carroll Skinner Jr. | Nurse Anesthetist, Certified Registered | 366 Mdos, Sgosa, 90 Hope Drive, Mountain Home Afb, ID 83648 | 2005-11-30 |
| 1023007846 | Craig Loyd Folsom | Dentist | 90 Hope Dr Bldg 6000, Mountain Home Afb, ID 83648 | 2005-10-14 |
| 1477547271 | Ron Stumbo | Pharmacist | Mountain Home Afb, Mountain Home Afb, ID 83648 | 2005-09-07 |
| 1154315943 | Georgette Ann Trezvant | Social Worker | 366 Medical Operations Squadron, 90 Hope Drive, Bldg 6000, Mt. Home Air Force Base, ID 83648 | 2005-09-07 |
| 1265948897 | Alyse Marie Denittis | Physician Assistant | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-12-19 |
| 1891224473 | Jared Getzlaff | Military Health Care Provider | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-06-07 |
| Find all providers in zip 83648 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881752913 | Richard K Thurston | Emergency Medicine | 229 S 7th Street, St Maries, ID 83861 | 2006-12-04 |
| 1255399820 | Warren William Gude | Emergency Medicine | 600 Robbins Road, The Center for Wound Healing and Hyperbaric Medicine, Boise, ID 83702 | 2006-05-03 |
| 1821529918 | Jonathan Subaitani | Emergency Medicine | 11197 W Fairview Ave, Boise, ID 83713 | 2017-03-21 |
| 1841679669 | Robert John Hagenberg IIi | Emergency Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642 | 2015-05-26 |
| 1194019406 | Michael Anderson | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2011-06-03 |
| 1508003104 | Rocky Mountain Emergency Physicians, LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201 | 2009-01-19 |
| 1225201148 | Rodney Gillman Jay Jr. | Emergency Medicine | 450 E Main St, Rexburg, ID 83440-2048 | 2008-04-11 |
| 1720114275 | North Idaho Immediate Care | Emergency Medicine | 750 N Syringa St, Suite 100, Post Falls, ID 83854-5275 | 2007-02-26 |
| 1407903669 | Debra K Mckinnon | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| 1710034988 | Kurt R Martyn | Emergency Medicine | 700 S Main St, Moscow, ID 83843-3056 | 2007-01-03 |
| Find all providers with the same taxonomy | ||||
| City | MOUNTAIN HOME AFB |
| Zip Code | 83648 |
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| 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.