LANDRU DEREK MEDVEC (NPI# 1225272073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225272073 |
| Entity Type | Individual |
| Full Name | LANDRU DEREK MEDVEC |
| Credential | IDMT |
| Practice Address |
2422 Arctic Ave Apt D Eielson Afb AK 99702 |
| Mailing Address |
2630 Central Ave Suite 1m07 Eielson Afb AK 99702-2301 |
| Practice Telephone | 9073724458 |
| Practice Fax Number | 9073724458 |
| Mailing Telephone | 9073776526 |
| Mailing Fax Number | 9073772763 |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2009-04-23 |
| 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 |
2422 ARCTIC AVE APT D |
| City | EIELSON AFB |
| State | AK |
| Zip Code | 99702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174864904 | Eric Noll | Optometrist | 2630 Central Ave # 3349, Eielson Afb, AK 99702 | 2013-03-04 |
| 1407125123 | Optical Center | Technician/Technologist | 451 Broadway Street, Eielson Afb Aafes Exchange, Eielson, AK 99702 | 2011-12-27 |
| 1063649234 | John Michael Strothenke | Military Health Care Provider | 2630 Central Avenue Suite 1, 354 Medical Operations Squadron, Clinical Medicine Flt, Eielson Air Force Base, AK 99702 | 2009-06-16 |
| 1780875617 | Victoria L Ketchum | Specialist | E. Cowles, Fairbanks Memorial Hospital, Fairbanks, AK 99702 | 2007-08-06 |
| 1689768103 | Angie M. Walker | Social Worker | 2630 Central Av, Suite 1m07, Eielson Afb, AK 99702 | 2006-10-02 |
| 1306945464 | 354th Medical Group Mdg | Military/U.S. Coast Guard Pharmacy | Bldg 3349 Central Ave, Eielson Afb, AK 99702 | 2006-09-22 |
| 1760442297 | Susan Mary Runyan | Dietitian, Registered | 354th Medical Group, 2630 Central Ave, Suite 1m07, Eielson Afb, AK 99702 | 2006-03-27 |
| 1972166916 | Andrew Joseph Colburn | Registered Nurse | 2630 Central Ave # 3349, Eielson Afb, AK 99702 | 2019-04-16 |
| 1952885121 | Anthony Ewell-kollmann | Dentist | 2630 Central Ave, Eielson Afb, AK 99702 | 2018-09-24 |
| 1306375704 | Robert Marshall Walter | Dentist | 2630 Central Ave Bldg 3349, Eielson Afb, AK 99702 | 2017-06-08 |
| Find all providers in zip 99702 | ||||
| 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 |
|---|---|---|---|---|
| 1578189387 | Eric Dylan Mason | Military Health Care Provider | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-06-18 |
| 1518586122 | Amanda Nichols | Military Health Care Provider | 2630 Central Ave # 3349, Eielson Afb, AK 99702-2301 | 2020-04-14 |
| 1104393446 | Matthew Gray | Military Health Care Provider | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2018-10-24 |
| 1730541038 | Matthew Robert Kramer | Military Health Care Provider | 2630 Central Ave # 3349, Eielson Afb, AK 99702-2301 | 2016-03-25 |
| 1821225913 | Alton E Doe Jr. | Military Health Care Provider | 2630 Central Ave, Ste 1, Eielson Afb, AK 99702-2301 | 2009-06-16 |
| 1982830287 | Julianne Marie Lujan | Military Health Care Provider | 2630 Central Ave, 354 Mdos Flight Medicine Clinic, Eielson Afb, AK 99702-2301 | 2009-06-02 |
| 1851534184 | Angelia Deanne Calder | Military Health Care Provider | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2009-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861093304 | Ryan Garcia | Military Health Care Provider | 673d Med Group, Jber, AK 99501 | 2020-11-02 |
| 1447850268 | Ryan Rene Reyes | Military Health Care Provider | 1024 Nordale Rd, North Pole, AK 99705-5154 | 2020-10-30 |
| 1285055129 | Jennifer Trout | Military Health Care Provider | 18226 Pioneer Dr, Eagle River, AK 99577-9331 | 2013-12-19 |
| 1063649234 | John Michael Strothenke | Military Health Care Provider | 2630 Central Avenue Suite 1, 354 Medical Operations Squadron, Clinical Medicine Flt, Eielson Air Force Base, AK 99702 | 2009-06-16 |
| 1851853048 | Jordan Matthew Cate | Military Health Care Provider | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2019-04-05 |
| 1457810657 | Mycala B Stedingh | Military Health Care Provider | 673 Mdg, 5955 Zeamer Ave, Jber, AK 99506 | 2019-03-18 |
| 1912481656 | Colin Michael Mullaly | Military Health Care Provider | 5955 Zeamer Ave, Anchorage, AK 99506-3702 | 2018-09-19 |
| 1104303320 | Luis Baltazar Baptista | Military Health Care Provider | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2018-07-20 |
| 1780172122 | Kathryn Noel Nyunt | Military Health Care Provider | 5955 Zeamer Ave, Anchorage, AK 99506-3702 | 2018-05-01 |
| 1922498096 | Kari Lynn Robinson | Military Health Care Provider | 5955 Zeamer Ave, Jber, AK 99506-3702 | 2015-01-28 |
| Find all providers with the same taxonomy | ||||
| City | EIELSON AFB |
| Zip Code | 99702 |
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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.