SCOTT B WYATT (NPI# 1720337462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720337462 |
| Entity Type | Individual |
| Full Name | SCOTT B WYATT |
| Credential | IDMT |
| Practice Address |
431 Meadowlark St Shaw Afb SC 29152-5019 |
| Practice Telephone | 3219611447 |
| Mailing Telephone | 3219611447 |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2013-06-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
431 MEADOWLARK ST |
| City | SHAW AFB |
| State | SC |
| Zip Code | 29152-5019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427667765 | Jaclyn C Hoffman | Registered Nurse | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2020-07-22 |
| 1881009033 | 20th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2014-06-26 |
| 1285068296 | Sidonia Lee Alo | Military Health Care Provider | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2013-08-27 |
| 1083966824 | Ryan R Landoll | Student in an Organized Health Care Education/Training Program | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2012-10-03 |
| 1699809475 | Jodi Ann Memery | Social Worker | 431 Meadowlark St, 20th Medical Group Mental Health Clinic, Shaw Afb, SC 29152-5019 | 2007-03-15 |
| 1881786879 | Daniel Anthony Blaz | Nurse Practitioner | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-09-28 |
| 1851490031 | 20th Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-09-22 |
| 1336112440 | 20th Medical Group Shaw | Military/U.S. Coast Guard Pharmacy | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487201695 | Ethan Lee Brockett | Dentist | Shaw Afb Dental Clinic, Shaw Afb, AE 29152 | 2019-08-22 |
| 1275066821 | Travis B Grindstaff | General Acute Care Hospital | 411 Polifka Dr, Shaw Afb, SC 29152 | 2017-04-10 |
| 1851791578 | Terrance Walker | Psychologist | 431 Meadow St, Sumter, SC 29152 | 2014-08-29 |
| 1124258967 | Jacqueline Mintz | Nurse Practitioner | 524 Nelson Ave, Shaw Afb, SC 29152 | 2009-07-14 |
| 1396970117 | Jennifer N Steele | Military Health Care Provider | 411 Meadowlark St, Shaw A F B, SC 29152 | 2009-05-22 |
| 1285899146 | Elizabeth Ann Vandevelde | Nurse Practitioner | 129 North Washington, Tuomey Healthcare System, Sumter, SC 29152 | 2008-07-21 |
| 1134211089 | Kibrom T Mehari | Dentist | 449 Shaw Dr, Shaw A F B, SC 29152 | 2006-09-29 |
| 1134155773 | Theresa Jean Ulichney | Registered Nurse | 420 Polifka Dr, Shaw Afb, SC 29152 | 2006-06-24 |
| 1366415184 | Kimberly Marie Shanks | Nurse Practitioner | 431 Meadowlark Rd, Shaw Afb, SC 29152 | 2006-02-10 |
| 1194710780 | Anthony Shawn Bankes | Family Medicine | 411 Medowlark, Shaw Afb, SC 29152 | 2005-09-20 |
| Find all providers in zip 29152 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285068296 | Sidonia Lee Alo | Military Health Care Provider | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2013-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770910788 | Heather Marie Phinney | Military Health Care Provider | 3345 Ashlynn Way, Sumter, SC 29154-8251 | 2013-10-04 |
| 1023380417 | John Becker | Military Health Care Provider | 134 Patriot Ln, Summerville, SC 29483-1889 | 2012-02-01 |
| 1770894966 | Kelli E. Vanpelt | Military Health Care Provider | 4023 Michigan Ave Apt B, Charleston, SC 29404-5541 | 2010-06-23 |
| 1689806291 | Jose L Pineiro | Military Health Care Provider | 437th Mdg, 204 West Hill Blvd, Charleston, SC 29404-4704 | 2009-08-14 |
| 1467687103 | Heather Nicole Eid | Military Health Care Provider | 5554 Whisperwood Dr, Dalzell, SC 29040-9670 | 2009-05-26 |
| 1396970117 | Jennifer N Steele | Military Health Care Provider | 411 Meadowlark St, Shaw A F B, SC 29152 | 2009-05-22 |
| 1720221013 | Cristy Jo Preslar | Military Health Care Provider | 364 Arthur Drive, Charleston Afb, SC 29404 | 2009-04-16 |
| 1588299457 | Albert Joseph Pendleton | Military Health Care Provider | 204 W Hill Blvd, Joint Base Charleston, SC 29404-4704 | 2020-03-11 |
| 1821631763 | Laura Simmons | Military Health Care Provider | 204 W Hill Blvd, Charleston, SC 29404-4704 | 2019-10-23 |
| 1356871032 | Karina Cortes | Military Health Care Provider | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2017-06-15 |
| Find all providers with the same taxonomy | ||||
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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.