Provider Demographics
NPI:1568696946
Name:HILL, WENDELL (IDMT)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:
Last Name:HILL
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 62 BOX 6915
Mailing Address - Street 2:UNIT 6585
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09643-6901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 62 BOX 6915
Practice Address - Street 2:UNIT 6585
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09643-6901
Practice Address - Country:US
Practice Address - Phone:314-722-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians