SAMUEL LEROY GRAHAM (NPI# 1932360815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1932360815 |
Entity Type | Individual |
Full Name | SAMUEL LEROY GRAHAM |
Practice Address |
14115 Fred and Al Key Rd Kiln MS 39556-8060 |
Practice Telephone | 2284661035 |
Practice Fax Number | 2284668962 |
Mailing Telephone | 2284661035 |
Mailing Fax Number | 2284668962 |
Enumeration Date | 2008-06-23 |
Last Update Date | 2011-03-16 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 286500000X | Military Hospital | Hospitals | ||
Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043376148 | Samuel Lyle Graham IIi | Internal Medicine | 1900 Lonlipman Ct, Louisville, KY 40207-1732 | 2006-12-31 |
1730181447 | Samuel Lee Graham | Psychologist | 1000 73rd St, Windsor Heights, IA 50311-1321 | 2005-08-12 |
Street Address |
14115 FRED AND AL KEY RD |
City | KILN |
State | MS |
Zip Code | 39556-8060 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144592841 | Brandon Wade Saksa | Emergency Medical Technician, Basic | 14115 Fred and Al Key Rd, Kiln, MS 39556-8060 | 2012-01-27 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1003167529 | Hancock Medical Health Services, Inc. | Nurse Practitioner | 6122 Cuevas Town Road, Kiln, MS 39556 | 2012-09-24 |
1568713071 | Hancock Medical Health Services | Nurse Practitioner | 4221 Kiln - Delisle Rd., Kiln, MS 39556 | 2012-09-24 |
1548511066 | Hancock Medical Health Services, Inc. | Nurse Practitioner | 7070 Stennis Airport Dr., Kiln, MS 39556 | 2012-09-24 |
1356692875 | Hancock Medical Health Services, Inc. | Nurse Practitioner | 7084 Stennis Airport Dr., Kiln, MS 39556 | 2012-09-24 |
1205955283 | Dana Hal Jones | Dentist | 17094 Hwy 603, Kiln, MS 39556 | 2007-03-28 |
1447549761 | Kiln Dental Center LLC | Dentist | 17094 Hwy 603, Kiln, MS 39556 | 2011-04-07 |
1952420937 | Martin Macrae Murphree | Dentist | 17094 Hwy 603, Kiln, MS 39556 | 2007-03-28 |
1922338037 | Cynthia Lee Dedeaux | Specialist/Technologist | 21271 Lawrence Ladner Rd, Kiln, MS 39556-6490 | 2010-01-12 |
1861920407 | Micah A Ladner Fnp-c LLC | Nurse Practitioner | 22549 Fenton Dedeaux Rd, Kiln, MS 39556-6576 | 2017-05-26 |
1417134230 | Bridget Ann Pendley | Licensed Practical Nurse | 22463 Fenton Dedeaux Rd, Kiln, MS 39556-6578 | 2008-01-23 |
Find all providers in zip 39556 |
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 |
---|---|---|---|---|
1043747553 | Rowdy Pameticky | Military Health Care Provider | 952 Poni Pl, Diamondhead, MS 39525-4135 | 2017-05-15 |
1528515046 | Nicolas Riley | Military Health Care Provider | 5501 Marvin Shields Blvd., Gulfport, MS 39501-5007 | 2016-09-01 |
1235519984 | Bradley Craig Wilson | Military Health Care Provider | 2807 Montclair Ave, Pascagoula, MS 39567-5287 | 2015-06-08 |
1477932200 | Michael Alexander Boartfield | Military Health Care Provider | 4033a Mallard Cv, Gulfport, MS 39501-2833 | 2015-05-26 |
1336536531 | Jeffrey Alexander Leemauk | Military Health Care Provider | 4010a Blue Heron Way, Gulfport, MS 39501-2815 | 2015-04-25 |
1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
1427316041 | Jeremiah John Baldwin | Military Health Care Provider | 5303 Marvin Shields Blvd, Gulfport, MS 39501-9013 | 2012-05-02 |
1215232830 | Jessica E Shores | Military Health Care Provider | 1000 Access Rd Bldg 2026, Pascagoula, MS 39567 | 2011-01-12 |
1124341763 | Trevor James Trout | Military Health Care Provider | 2603 Lower Gainesville Rd, Stennis Space Center, MS 39529-0001 | 2010-03-10 |
1245563162 | Jenesia Arielle Dillow Ordonia | Military Health Care Provider | 3158b Holloway Dr, Gulfport, MS 39501-9030 | 2009-09-10 |
Find all providers with the same taxonomy |
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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.