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“Independent Duty Medical Technicians” (Shaw Afb, SC)

Location: Shaw Afb, SC
Taxonomy: Independent Duty Medical Technicians.

A provider can have more than one taxonomy code. It is critical to register all applicable taxonomy codes with NPPES and to use the correct taxonomy code to represent the specific specialty when filing claims. This will assist in more accurate and timely processing of claims.
1003585399 — DESMOND JACOB MARROQUIN
Practice Location Address:
420 POLIFKA DR
SHAW AFB SC
29152-5100
Practice Phone: 803-885-0249
1285068296 — SIDONIA LEE ALO IDMT
Practice Location Address:
431 MEADOWLARK ST
SHAW AFB SC
29152-5019
Practice Phone: 803-895-6527
1346670551 — JESSICA A. POWNELL
Practice Location Address:
420 POLIFKA DR
SHAW AFB SC
29152-5100
Practice Phone: 803-895-6605
1558025429 — ERIC BLACK IDMT
Practice Location Address:
431 MEADOWLARK ST
SHAW AFB SC
29152-5019
Practice Phone: 803-895-2273
1720337462 — SCOTT B WYATT IDMT
Practice Location Address:
431 MEADOWLARK ST
SHAW AFB SC
29152-5019
Practice Phone: 321-961-1447

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