TIMOTHY BLAKE WILDER


Address: 310 W Losey St, Scott Afb, IL 62225-5250
Phone: 6182568970

TIMOTHY BLAKE WILDER (NPI# 1184858045) 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) 1184858045
Entity Type Individual
Full Name TIMOTHY BLAKE WILDER
Credential IDMT
Practice Address 310 W Losey St
Scott Afb
IL 62225-5250
Mailing Address 68 Circle Dr
Fairview Heights
IL 62208-3303
Practice Telephone 6182568970
Mailing Telephone 6183943552
Enumeration Date 2009-05-07
Last Update Date 2009-05-07
Gender Code M
Is Sole Proprietor Y

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

Other Providers TIMOTHY WILDER

NPI Name Taxonomy Address Enumeration
1568446144 Timothy M Wilder Counselor 4656 Brambleton Ave, Roanoke, VA 24018-3437 2005-12-06

Office Location

Street Address 310 W LOSEY ST
City SCOTT AFB
State IL
Zip Code 62225-5250

Providers in the same location

NPI Name Taxonomy Address Enumeration
1205839727 Toney L Banks Nurse Anesthetist, Certified Registered 310 W Losey St, Scott Afb, IL 62225-5250 2005-05-30
1841814852 Hilary Elizabeth Parsons Student in an Organized Health Care Education/Training Program 310 W Losey St, Scott Afb, IL 62225-5250 2020-06-04
1447874722 Mauranda Nikki Bembry Social Worker 310 W Losey St, Scott Afb, IL 62225-5250 2020-06-03
1437778016 Mark Alan Underhill Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2020-04-13
1194353276 Kolin Daniel Cookson Student in an Organized Health Care Education/Training Program 310 W Losey St, Scott Afb, IL 62225-5250 2020-04-01
1831723592 Linh Thuy Truong Dentist 310 W Losey St, Scott Afb, IL 62225-5250 2020-03-02
1346890894 Crystal June Garcia Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2019-09-17
1740835602 Andres Alejandro Paredes Physician Assistant 310 W Losey St, Scott Afb, IL 62225-5250 2019-08-07
1215580386 Ryan Taylor Blalock Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2019-07-18
1063975001 Collin Schroeder Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2019-04-08
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1861011645 Cheryl D Jones Registered Nurse 375th Mdg, 310 W. Losey Street, Scott Afb, IL 62225 2020-04-13
1649836123 Benjamin Truong Student in an Organized Health Care Education/Training Program Scott Air Force Base, 307 West Losey Street Building #1535, Apo, AA 62225 2019-05-10
1558925669 Brian Ng Student in an Organized Health Care Education/Training Program South Drive, Scott Afb, Illinois, Apo, AA 62225 2019-04-24
1841853710 Lance Scott Mcgavin Student in an Organized Health Care Education/Training Program 307 West Losey Street., Building #1535, Scott Afb, IL 62225 2019-04-17
1629503180 Joshua Bryce Kessack General Practice 375 Amds, 310 Losey St, Scott Afb, IL 62225 2017-04-21
1265988059 Jennifer Nicole Laurence Dentist 703 Seibert Rd Ste 5, Scott Afb, IL 62225 2016-08-31
1578940755 Usv Optical Inc Eyewear Supplier (Equipment, not the service) 207 W. Winters St., Bldg 1981, Scott Afb, IL 62225 2015-04-27
1891193652 Diana Meyer Social Worker Scott Afb, Apo, AA 62225 2014-12-10
1801210273 Robie Victoria Hughes Registered Nurse 310 W Losey Street, Scott Air Force Base, IL 62225 2014-02-06
1487998746 Melissa Dawn Goff Military Health Care Provider 310 West. Losey Street, Scott Afb, IL 62225 2012-11-26
Find all providers in zip 62225

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
1043787468 Zachary B Reynolds Military Health Care Provider 4691 Petty Ct, Scott Afb, IL 62225-6195 2018-10-24
1275954125 D'mario Revere Military Health Care Provider 4465 George Washington Dr, Scott Afb, IL 62225-6000 2013-12-19
1487998746 Melissa Dawn Goff Military Health Care Provider 310 West. Losey Street, Scott Afb, IL 62225 2012-11-26
1639313240 Raymond J Flaiz Military Health Care Provider 312 W. Losey Str, 375 Mdg/sgopg, Scott Afb, IL 62225 2009-04-27
1437778016 Mark Alan Underhill Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2020-04-13
1346890894 Crystal June Garcia Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2019-09-17
1215580386 Ryan Taylor Blalock Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2019-07-18
1063975001 Collin Schroeder Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2019-04-08
1528539756 Joe Calvin Durham II Military Health Care Provider 310 W Losey St, Scott Afb, IL 62225-5250 2018-12-16
1770818056 Patrick Christopher Korthuis Military Health Care Provider 2400 East Dr, Bldg 3650 Rm 135, Scott Afb, IL 62225-5408 2009-10-05
Find all providers in SCOTT AFB

Competitor

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City SCOTT AFB
Zip Code 62225

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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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