MR. MICHAEL C ETHEREDGE II


Address: 77 Nealy Ave, Langley Afb, VA 23665-2040
Phone: 7577646800

MR. MICHAEL C ETHEREDGE II (NPI# 1639729106) 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) 1639729106
Entity Type Individual
Full Name MR. MICHAEL C ETHEREDGE II
Credential IDMT
Practice Address 77 Nealy Ave
Langley Afb
VA 23665-2040
Practice Telephone 7577646800
Enumeration Date 2019-09-17
Last Update Date 2019-09-17
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 77 NEALY AVE
City LANGLEY AFB
State VA
Zip Code 23665-2040

Providers in the same location

NPI Name Taxonomy Address Enumeration
1568096634 Angela Rene Tuckett Registered Nurse 77 Nealy Ave, Langley Afb, VA 23665-2040 2020-02-27
1588123962 Lynzy Star Lee Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2040 2019-03-15
1720562531 Alexander Isaac Benavidez Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2005 2018-09-18
1033516257 Corey Lee Czajka Emergency Medical Technician, Basic 77 Nealy Ave, Langley Afb, VA 23665-2040 2014-12-03
1285054569 Kristen E Spratt Internal Medicine 77 Nealy Ave, Langley Afb, VA 23665-2040 2014-04-24
1750700837 Christopher Gurries Dentist 77 Nealy Ave, Langley Afb, VA 23665-2040 2014-04-16
1093153447 Steven Kyle Hammond I Military Health Care Provider 77 Nealy Ave, 633d Mdg, Langley Afb, VA 23665-2040 2013-06-07
1215277454 Jason Kieffer Physician Assistant 77 Nealy Ave, Langley Afb, VA 23665-2040 2013-02-26
1295074714 Ashley Nicole Abbott Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2040 2013-02-04
1932461282 Clifford Rissler Nolt Family Medicine 77 Nealy Ave, Langley Afb, VA 23665 2012-06-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1982228938 Mai Stern Student in an Organized Health Care Education/Training Program Langley Afb Dental Clinic, Hampton, VA 23665 2020-06-05
1386273449 Nicholas Thomas Nelson Military Health Care Provider 633d Medical Group, 76 Nealy Ave, Building #92, Apo, AA 23665 2020-04-02
1316574809 Kimberly C Easterling Student in an Organized Health Care Education/Training Program 76 Nealy Avenue, Joint Base Langley-eustis, Hampton, VA 23665 2020-03-24
1851950026 Erin Leigh Baldridge Dentist Joint Base Langley Eustis Dental Clinic, 76 Nealy Ave, Apo, AA 23665 2019-06-11
1669950739 Anthony Interrante IIi Nurse Practitioner Usaf Hospital Langley, 77 Nealy Avenue, Hampton, VA 23665 2018-08-01
1588189310 Stacey Marie Jackson Psychologist 11 Nealy Blvd, Hampton, VA 23665 2017-08-14
1285062216 Michael John Vietti Physician Assistant 633 Mdg 77 Nealy Ave, Yorktown, VA 23665 2013-10-30
1396182234 Micaela Jane Dagucon General Practice 633d Mdg/sghc, 77 Nealy Avenue, Joint Base Langley-eustis, VA 23665 2013-06-02
1912212051 Michele Leigh Shirley Pharmacist 633d Medical Group Hospital, 77 Nealy Avenue, Building 257, Joint Base Langley-eustis, VA 23665 2010-08-13
1497915219 Stephen Warren Porter Dentist 76 Nealy Ave, 1st Dental Squadron/sgd, Langley Air Force Base, VA 23665 2008-06-16
Find all providers in zip 23665

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
1225464837 Stephen Mitchell Harris Military Health Care Provider 49 Spruce St, Pcs Box 1000, Langley Afb, VA 23665-2800 2013-09-16
1225263320 Eddie C Webb Military Health Care Provider 162 Dodd Blvd, Ste 100, Langley Afb, VA 23665-1916 2009-05-19
1588123962 Lynzy Star Lee Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2040 2019-03-15
1720562531 Alexander Isaac Benavidez Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2005 2018-09-18
1093153447 Steven Kyle Hammond I Military Health Care Provider 77 Nealy Ave, 633d Mdg, Langley Afb, VA 23665-2040 2013-06-07
1295074714 Ashley Nicole Abbott Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2040 2013-02-04
1730449018 Sarah Desiree Windsor Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2040 2012-05-21
1336445089 Ashley Blackwell Military Health Care Provider 77 Nealy Ave, Langley Afb, VA 23665-2040 2011-01-28
1932334752 Keiyata K Styerjames Military Health Care Provider 77 Nealy Ave, 1st Medical Group, Langley Afb, VA 23665-2040 2009-05-22
1386879104 Alexis D Lewis Military Health Care Provider 77 Nealy Ave, 1st Medical Group, Langley Afb, VA 23665-2040 2009-05-22
Find all providers in LANGLEY AFB

Competitor

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City LANGLEY AFB
Zip Code 23665

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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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