IndividualActive
Ivan Vicente, IDMT
NPI 1710201553 · Independent Duty Medical Technicians · Ellsworth Afb, SD
Provider details
- NPI number
- 1710201553
- Entity type
- Individual
- Primary specialty
- Independent Duty Medical TechniciansOther Service Providers
- Credential
- IDMT
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Other Service Providers
Practice location
433 Black Elk Ct
Ellsworth Afb, SD 57706-1847
Phone: (605) 521-3502
Approximate (ZIP-level) locationGet directions
Mailing address
433 Black Elk Ct
Ellsworth Afb, SD 57706-1847
Registry dates
- Enumerated
- 2010-03-23
- Last updated
- 2010-03-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.