MR. SHANE A LACAILLADE (NPI# 1881829497) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881829497 |
| Entity Type | Individual |
| Full Name | MR. SHANE A LACAILLADE |
| Credential | IDMT |
| Practice Address |
331 Sijan Ave Whiteman Afb MO 65305-1269 |
| Mailing Address |
1307 Shamrock Ct Warrensburg MO 64093-2490 |
| Practice Telephone | 6606871191 |
| Mailing Telephone | 6607473477 |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2009-05-27 |
| 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 |
331 SIJAN AVE |
| City | WHITEMAN AFB |
| State | MO |
| Zip Code | 65305-1269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760471635 | Tammy Colleen Karamarinov | Pharmacist | 331 Sijan Ave, Whiteman Afb, MO 65305 | 2005-10-13 |
| 1023644622 | Whitney Nicole Brooks | Social Worker | 331 Sijan Ave, Whiteman Afb, MO 65305-1269 | 2020-03-16 |
| 1093358293 | Margaret Stepaniak | Pharmacist | 331 Sijan Ave, Whiteman Afb, MO 65305 | 2019-10-21 |
| 1740786185 | Abigail Hope Peters | Dentist | 331 Sijan Ave, Whiteman Afb, MO 65305-1269 | 2018-04-04 |
| 1407395213 | Matthew Robert Land | Physician Assistant | 331 Sijan Ave, Whiteman Afb, MO 65305 | 2017-02-14 |
| 1487020269 | Kelsey Geiger | Dentist | 331 Sijan Ave, Whiteman Afb, MO 65305 | 2015-08-17 |
| 1215339007 | Chauna Weyermuller | Nurse Practitioner | 331 Sijan Ave, Whiteman Afb, MO 65305-1269 | 2014-09-23 |
| 1801175062 | Brianne Daigh Manglitz | Physician Assistant | 331 Sijan Ave, Whiteman Afb, MO 65305 | 2011-08-05 |
| 1144550724 | James Matthew Campbell | Physician Assistant | 331 Sijan Ave, Whiteman Afb, MO 65305-1269 | 2010-01-05 |
| 1639321128 | Audrey M Simpson | Pharmacist | 331 Sijan Ave, Whiteman Afb, MO 65305 | 2008-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366928350 | Jeffrey D Bundrick | Physical Therapist | Whiteman Air Force Base, Knob Noster, MO 65305 | 2018-07-13 |
| 1841730280 | Joseph Sharp | Student in an Organized Health Care Education/Training Program | 162 Sijen Ave, Knob Noster, MO 65305 | 2017-03-05 |
| 1295116572 | Caleb James | Family Medicine | 331 Sijan, Whiteman Afb, MO 65305 | 2015-06-12 |
| 1679627814 | Linda May Jones | Social Worker | Whiteman Air Force Base 509 Medical Group, 331 Sijan Ave, Whiteman Afb, MO 65305 | 2007-01-23 |
| 1265454367 | Mary Anne Kiel | Pediatrics | 509th Medical Group, 331 Sijan Avenue, Whiteman Afb, MO 65305 | 2006-07-25 |
| 1609419142 | Ryan H Boothe | Nurse Practitioner | 331 Sijan Ave Bldg 2032, Whiteman Afb, MO 65305 | 2019-10-28 |
| 1659750206 | Erin Katie Dunn | Social Worker | 331 Sijan Avenue, Knob Noster, MO 65305 | 2015-05-28 |
| 1962899518 | Raven Lambert Welsh | Pediatrics | 331 Sijen Ave, Whiteman Afb, MO 65305 | 2015-04-22 |
| 1942695952 | Sadie Markey | Emergency Medicine | 331 Sijen Ave, Whiteman Air Force Base, MO 65305 | 2015-04-06 |
| 1730574963 | Jacob Matthew Shepherd | Family Medicine | 331 Sijen Ave, Whiteman Afb, MO 65305 | 2015-04-03 |
| Find all providers in zip 65305 | ||||
| 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 |
|---|---|---|---|---|
| 1821339268 | Donald Gordon Berger II | Military Health Care Provider | 208 March Dr, Whiteman Afb, MO 65305-1214 | 2013-03-11 |
| 1356667687 | Benjamen E Pennington | Military Health Care Provider | 310 Houx Dr, Whiteman Afb, MO 65305-1130 | 2010-04-12 |
| 1992203764 | Dylan John Kielcheski | Military Health Care Provider | 331 Sijen Ave, Whiteman Afb, MO 65305-1269 | 2018-01-26 |
| 1689064875 | Merlin Jewell | Military Health Care Provider | 331 Sijen Ave, Whiteman Afb, MO 65305-1269 | 2015-01-27 |
| 1346670551 | Jessica A. Pownell | Military Health Care Provider | 331 Sijen Ave, Whiteman Afb, MO 65305-1269 | 2013-11-25 |
| 1316173313 | Andrea Darcy Richards | Military Health Care Provider | 331 Sijen Ave, Whiteman Afb, MO 65305-1269 | 2009-06-04 |
| 1093940793 | Haidee Hasty | Military Health Care Provider | 331 Sijen Ave, Whiteman Afb, MO 65305-1269 | 2009-05-26 |
| 1780818229 | Luis Hernandez | Military Health Care Provider | 331 Sijen Ave, Whiteman Afb, MO 65305-1269 | 2009-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942568662 | Jacob Daniel Rosko | Military Health Care Provider | 539 Se Dd Hwy Lot 5, Warrensburg, MO 64093-8300 | 2012-05-01 |
| 1417576018 | Zachory Woodard | Military Health Care Provider | 331 Sijen Ave, Whiteman Air Force Base, MO 65305-1269 | 2020-04-13 |
| 1598061269 | Marcus L Bell | Military Health Care Provider | 126 Missouri Ave, Fort Leonard Wood, MO 65473 | 2011-01-28 |
| 1417182460 | Jason Allen Miller | Military Health Care Provider | 331 Sijen Ave, Whiteman Air Force Base, MO 65305-1269 | 2009-05-20 |
| 1164564639 | Thomas James Miles | Military Health Care Provider | 1222 Spruce St Rm 2.102a, Saint Louis, MO 63103-2854 | 2007-02-13 |
| City | WHITEMAN AFB |
| Zip Code | 65305 |
Please comment or provide details below to improve the information on MR. SHANE A LACAILLADE.
| 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.