Provider Demographics
NPI:1306080296
Name:PENNINGTON, JAMES CHRISTOPHER (IDMT/NREMT-P)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:IDMT/NREMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 CHASTAIN LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3326
Mailing Address - Country:US
Mailing Address - Phone:702-417-3339
Mailing Address - Fax:702-404-0425
Practice Address - Street 1:BLDG 1032 CREECH AFB
Practice Address - Street 2:CAFB MEDICAL AID STATION
Practice Address - City:INDIAN SPRINGS
Practice Address - State:NV
Practice Address - Zip Code:89018
Practice Address - Country:US
Practice Address - Phone:702-404-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVP8033950146L00000X
1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic