MR. CHADDRICK LENDON JACK (NPI# 1922068246) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922068246 |
| Entity Type | Individual |
| Full Name | MR. CHADDRICK LENDON JACK |
| Practice Address |
10651 E St Corpus Christi TX 78419-5130 |
| Practice Telephone | 3619612688 |
| Mailing Telephone | 3619612688 |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2008-02-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
1710I1002X | TX | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | INDEPENDENT DUTY CORPSMAN | 1710I1002X | 01 |
| Street Address |
10651 E ST |
| City | CORPUS CHRISTI |
| State | TX |
| Zip Code | 78419-5130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306849286 | William G. Beck | Specialist | 10651 E St, Corpus Christi, TX 78419-5130 | 2005-05-24 |
| 1356992713 | Diane Marie Everett | Pharmacist | 10651 E St, Corpus Christi, TX 78419-5130 | 2019-09-26 |
| 1790139905 | Finis Ashton Taylor IIi | Psychiatry & Neurology | 10651 E St, Corpus Christi, TX 78419-5130 | 2016-04-14 |
| 1568879401 | Traci Burrell | Clinic/Center | 10651 E St, Attention Medical Staff Services Office, Corpus Christi, TX 78419-5130 | 2014-07-11 |
| 1215275110 | Rhett Arthur Ketschke | General Practice | 10651 E St, Corpus Christi, TX 78419-5130 | 2013-01-28 |
| 1497007785 | Joshua John Morgan | Nurse Practitioner | 10651 E St, Corpus Christi, TX 78419-5130 | 2012-10-10 |
| 1821349002 | Naval Health Clinic Corpus Christi | Clinic/Center | 10651 E St, Corpus Christi, TX 78419-5130 | 2012-09-27 |
| 1649562398 | Colleen Anne Graham | Physical Therapist | 10651 E St, Physical Therapy Clinic, Corpus Christi, TX 78419-5130 | 2011-05-12 |
| 1497054258 | Kevin Hoang | Optometrist | 10651 E St, Corpus Christi, TX 78419-5130 | 2011-03-19 |
| 1558670166 | Brandi Nicole Milmo | Military Health Care Provider | 10651 E St, Corpus Christi, TX 78419-5130 | 2010-09-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528425840 | Danny X Xu | Emergency Medical Technician, Paramedic | Naval Health Clinic Corpus Christi, 10651 E. Street, Corpus Christi, TX 78419 | 2016-01-16 |
| 1457580235 | Jessica Nichols | Nurse Practitioner | 10651 E. Street, Naval Health Clinic Corpus Christi, Corpus Christi, TX 78419 | 2009-07-14 |
| 1770607145 | Gideon Allen Kain | Military Health Care Provider | 10651 E St., Naval Health Clinic Corpus Christi, Corpus Christi, TX 78419 | 2007-03-19 |
| 1427157668 | Naval Health Clinic Corpus Christi | Military/U.S. Coast Guard Pharmacy | 10651 E St Bldg H100, Corpus Christi, TX 78419 | 2006-09-22 |
| 1417307349 | Erin Irene Ausborn | Family Medicine | 10651 E St., Corpus Christi, TX 78419 | 2016-06-22 |
| 1033521737 | Naval Health Clinic Corpus Christi | Military/U.S. Coast Guard Pharmacy | 10651 E St Bldg H100, Naval Health Clinic Corpus Christi, Corpus Christi, TX 78419 | 2014-05-29 |
| 1811191984 | Naval Ambulatory Care Center,corpus Christi, Texas | Clinic/Center | Nas Corpus Christi, Corpus Christi, TX 78419-5021 | 2007-06-13 |
| 1639426059 | William Joseph Bates | Dentist | 10651 E St Bldg 100, Corpus Christi, TX 78419-5130 | 2012-08-06 |
| 1669489175 | Lawrence Anthony Ramirez | Family Medicine | 10651 E St Bldg H-100, Corpus Christi, TX 78419-5130 | 2006-08-01 |
| 1689642506 | Kenneth Wayne Graves | Military Health Care Provider | Naval Hospital Corpus Christi, 10651 E Street, Corpus Christi, TX 78419-5130 | 2006-03-08 |
| Find all providers in zip 78419 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518337013 | John Cantu | Military Health Care Provider | 3945 Tripoli Dr, Corpus Christi, TX 78415-3348 | 2015-09-28 |
| 1689970535 | Michael G. Phillips | Military Health Care Provider | 2621 Las Brisas St, Corpus Christi, TX 78414-5014 | 2011-02-09 |
| 1194931311 | Jesus Jimenez | Military Health Care Provider | 1017a Huey Dr, Corpus Christi, TX 78418 | 2007-05-15 |
| 1770607145 | Gideon Allen Kain | Military Health Care Provider | 10651 E St., Naval Health Clinic Corpus Christi, Corpus Christi, TX 78419 | 2007-03-19 |
| 1417914631 | Jeffrey William Ard | Military Health Care Provider | 10651 E St, Corpus Christi, TX 78419-5130 | 2006-05-01 |
| 1275590184 | James E Day | Military Health Care Provider | 10651 E St, Corpus Christi, TX 78419-5130 | 2006-04-26 |
| 1124097720 | Michael Davis | Military Health Care Provider | 10651 E St, Corpus Christi, TX 78419-5130 | 2006-03-16 |
| 1689642506 | Kenneth Wayne Graves | Military Health Care Provider | Naval Hospital Corpus Christi, 10651 E Street, Corpus Christi, TX 78419-5130 | 2006-03-08 |
| 1568439933 | Lee E Pradia Jr. | Military Health Care Provider | 10651 E St, Naval Hospital, Corpus Christi, TX 78419-5130 | 2006-03-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225581481 | Kenneth Perry Vantassel | Military Health Care Provider | 1410 Woodfair Dr, Richmond, TX 77406-6609 | 2016-07-24 |
| 1528430980 | Tomasz Orent | Military Health Care Provider | 26885 Manor Falls Dr, Kingwood, TX 77339-7709 | 2015-10-26 |
| 1699144428 | Alberto Gonzalez | Military Health Care Provider | 102 Redrock Dr, San Antonio, TX 78213-4526 | 2015-09-22 |
| 1275938375 | Ricardo Jaramillo | Military Health Care Provider | 7016 Austrian Pine, Brownsville, TX 78526 | 2014-10-31 |
| 1942637087 | Matthew Alan Robichaux | Military Health Care Provider | 13500 White Tail Trl, Austin, TX 78736-7422 | 2013-10-03 |
| 1417223710 | Adam Anthony Garcia | Military Health Care Provider | 12080 Paseo De Amor Ln, El Paso, TX 79936-4499 | 2012-03-30 |
| 1124306329 | David G Morales Jr. | Military Health Care Provider | 9180 Tenango Dr, El Paso, TX 79907-3257 | 2011-07-22 |
| 1912208216 | Shepley Allen Reimer | Military Health Care Provider | 3555 Patch Rd, Fort Sam Houston, TX 78234-1200 | 2010-11-03 |
| 1750690400 | John Douglas Compton Jr. | Military Health Care Provider | 13506 Wood Terrace Dr, Houston, TX 77038-1533 | 2010-09-29 |
| 1396077020 | Christopher John Robinson | Military Health Care Provider | 4006 Waverly Rd, Corinth, TX 76208-5270 | 2010-02-05 |
| Find all providers with the same taxonomy | ||||
| City | CORPUS CHRISTI |
| Zip Code | 78419 |
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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.