MR. JEFFRIE NEIL MAYBERRY (NPI# 1407086473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407086473 |
| Entity Type | Individual |
| Full Name | MR. JEFFRIE NEIL MAYBERRY |
| Credential | IDMT |
| Practice Address |
90 Hope Dr Bldg 6000 Mountain Home A F B ID 83648-1062 |
| Practice Telephone | 2088287100 |
| Mailing Telephone | 2088287100 |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |
| 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 |
90 HOPE DR BLDG 6000 |
| City | MOUNTAIN HOME A F B |
| State | ID |
| Zip Code | 83648-1062 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942533419 | Kristen Anne Lewis | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home A F B, ID 83648-1062 | 2009-09-15 |
| 1942430178 | Joe Cabalhin Dittman | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home A F B, ID 83648-1062 | 2009-07-22 |
| 1881824159 | Omar D Hernandez Solano | Military Health Care Provider | 90 Hope Dr Bldg 6000, 366 Amds/sgpf, Mountain Home A F B, ID 83648-1062 | 2009-07-21 |
| 1194959908 | Joseph Paul Keddie | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home A F B, ID 83648-1062 | 2009-05-07 |
| 1194976332 | Jeffrey Blaine Robinson | Dentist | 90 Hope Dr Bldg 6000, Mountain Home A F B, ID 83648-1062 | 2008-10-07 |
| 1154451342 | Beatriz C.s. Spencer | Physician Assistant | 90 Hope Dr Bldg 6000, Mountain Home Afb, Mountain Home A F B, ID 83648-1062 | 2007-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851528392 | Amy Jo Glover | Military Health Care Provider | 90 Hope Dr. Bldg 6000, Mountain Home, ID 83648 | 2009-06-11 |
| 1306051065 | Thomas Michael Smith | Social Worker | 90 Hope Dr Bldg 1900, Mountain Home Afb, ID 83648 | 2007-05-14 |
| 1316005143 | Ronald Wesley Bailey | Radiology | Mountain Home Afb Medical Group, 90 Hope Drive, Building 6000, Mountain Home Afb, ID 83648 | 2006-12-05 |
| 1992780597 | Randall Jay Moore | Preventive Medicine | 366mdg/sgpf, 90 Hope Drive; Bldg 6000, Mountain Home Afb, ID 83648 | 2005-12-07 |
| 1356325666 | Joseph Carroll Skinner Jr. | Nurse Anesthetist, Certified Registered | 366 Mdos, Sgosa, 90 Hope Drive, Mountain Home Afb, ID 83648 | 2005-11-30 |
| 1477547271 | Ron Stumbo | Pharmacist | Mountain Home Afb, Mountain Home Afb, ID 83648 | 2005-09-07 |
| 1154315943 | Georgette Ann Trezvant | Social Worker | 366 Medical Operations Squadron, 90 Hope Drive, Bldg 6000, Mt. Home Air Force Base, ID 83648 | 2005-09-07 |
| 1265948897 | Alyse Marie Denittis | Physician Assistant | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-12-19 |
| 1891224473 | Jared Getzlaff | Military Health Care Provider | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-06-07 |
| 1548796527 | Derek J Dutson | Dentist | 90 Hope Dr, Mountain Home Afb, ID 83648 | 2017-05-11 |
| Find all providers in zip 83648 | ||||
| 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 |
|---|---|---|---|---|
| 1760626584 | Casey Lee Burns | Military Health Care Provider | 84 Bomber Rd, 726th Air Control Squadron, Mountain Home A F B, ID 83648-5272 | 2009-04-23 |
| 1669765871 | April Denise Paciotti | Military Health Care Provider | 90 Hope Dr, Bld 6000, Mountain Home A F B, ID 83648-1057 | 2011-05-20 |
| 1942533419 | Kristen Anne Lewis | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home A F B, ID 83648-1062 | 2009-09-15 |
| 1942430178 | Joe Cabalhin Dittman | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home A F B, ID 83648-1062 | 2009-07-22 |
| 1881824159 | Omar D Hernandez Solano | Military Health Care Provider | 90 Hope Dr Bldg 6000, 366 Amds/sgpf, Mountain Home A F B, ID 83648-1062 | 2009-07-21 |
| 1194959908 | Joseph Paul Keddie | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home A F B, ID 83648-1062 | 2009-05-07 |
| 1306070446 | Brandi Adele Mackey | Military Health Care Provider | 84 Bomber Rd, Mountain Home A F B, ID 83648-5272 | 2009-05-04 |
| 1518101245 | Dane A. Looman | Military Health Care Provider | 84 Bomber Rd, 726 Acs/sg, Mountain Home A F B, ID 83648-5272 | 2009-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326311259 | Matthew Turner | Military Health Care Provider | 232 Ne Verde Ct, Mountain Home, ID 83647-3715 | 2012-02-23 |
| 1972813400 | Stacey Karen Bays | Military Health Care Provider | 509 Lynwood Blvd, Twin Falls, ID 83301-4132 | 2010-10-18 |
| 1851528392 | Amy Jo Glover | Military Health Care Provider | 90 Hope Dr. Bldg 6000, Mountain Home, ID 83648 | 2009-06-11 |
| 1922585140 | Heather Ford | Military Health Care Provider | 90 Hope Dr, Mountain Home Afb, ID 83648-1057 | 2018-07-20 |
| 1528551751 | Ryan D Kainrath | Military Health Care Provider | 90 Hope Dr, Mountain Home Afb, ID 83648-1057 | 2018-06-12 |
| 1598298135 | Zack Hunter | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home Afb, ID 83648-1062 | 2017-04-11 |
| 1861800096 | Tyree Wolf | Military Health Care Provider | 90 Hope Dr Bldg 6000, Mountain Home Afb, ID 83648-1062 | 2014-07-31 |
| 1174862692 | Dennis Jacob Reuter | Military Health Care Provider | 90 Hope Dr, Mountain Home Afb, ID 83648-1057 | 2013-02-04 |
| 1447480686 | Julian Keith Little | Military Health Care Provider | Mountain Home Afb, 90 Hope Dr. Bldg 6000/366 Med Gp/amds/sgpf, Mountain Home, ID 83648 | 2009-07-22 |
| 1093943870 | Dandy Rae Aaron | Military Health Care Provider | 90 Hope Drive Bldg 6000, Mountain Home, ID 83648-1062 | 2009-06-30 |
| Find all providers with the same taxonomy | ||||
| City | MOUNTAIN HOME A F B |
| Zip Code | 83648 |
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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.