Healthcare Provider Details

I. General information

NPI: 1306080296
Provider Name (Legal Business Name): JAMES CHRISTOPHER PENNINGTON IDMT/NREMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 1032 CREECH AFB CAFB MEDICAL AID STATION
INDIAN SPRINGS NV
89018
US

IV. Provider business mailing address

5112 CHASTAIN LN
LAS VEGAS NV
89115-3326
US

V. Phone/Fax

Practice location:
  • Phone: 702-404-1142
  • Fax:
Mailing address:
  • Phone: 702-417-3339
  • Fax: 702-404-0425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP8033950
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: