RONNIE LEE GODBOLT (NPI# 1104054659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104054659 |
| Entity Type | Individual |
| Full Name | RONNIE LEE GODBOLT |
| Credential | IDMT |
| Practice Address |
204 W Hill Blvd Charleston Afb SC 29404-4704 |
| Practice Telephone | 8439636936 |
| Practice Fax Number | 8439636903 |
| Mailing Telephone | 8439636936 |
| Mailing Fax Number | 8439636903 |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2009-06-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
204 W HILL BLVD |
| City | CHARLESTON AFB |
| State | SC |
| Zip Code | 29404-4704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831186360 | Darrell Kevin Tegtmeyer | Physician Assistant | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2005-09-30 |
| 1164080768 | Eric Wayne Robertson | Registered Nurse | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2019-05-30 |
| 1467938290 | Nicholas Trudo | Physician Assistant | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2018-07-16 |
| 1235655754 | Jessica Reynolds | Pharmacist | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2017-08-16 |
| 1356871032 | Karina Cortes | Military Health Care Provider | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2017-06-15 |
| 1093250839 | Thi Nguyen | Pharmacist | 204 W Hill Blvd, 628th Medical Group, Charleston Afb, SC 29404-4704 | 2017-01-03 |
| 1952857393 | Krystal Hasselvander | Social Worker | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2016-08-26 |
| 1447650502 | Jeffrey Chase Yee | Dentist | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2014-08-26 |
| 1659770980 | Khiem Nguyen | Dentist | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2014-08-22 |
| 1063852978 | Chantell Renee Mckee | Family Medicine | 204 W Hill Blvd, Charleston Afb, SC 29404 | 2013-06-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346751971 | James Tyrone Wilder | Social Worker | B, 1001 Michigan Ave, Joint Base, Charleston, SC 29404 | 2017-10-23 |
| 1033422902 | Michael Ryan Moore | Physical Therapist | 628th Medical Group, 204 West Hill Blvd, Charleston, SC 29404 | 2010-07-21 |
| 1720221013 | Cristy Jo Preslar | Military Health Care Provider | 364 Arthur Drive, Charleston Afb, SC 29404 | 2009-04-16 |
| 1336237627 | Douglas Vail Campbell | Psychologist | 437mdos/lssc - 204 West Hill Blvd, Charleston Afb, SC 29404 | 2006-10-11 |
| 1124019914 | Neal Robert Taylor | Family Medicine | 628 Medical Group 204 W. Hill Blvd, Jb Charleston, SC 29404 | 2005-11-02 |
| 1295092328 | Suzanne M O'shea | Registered Nurse | 204 W. Hill Blvd, Charleston, SC 29404-0000 | 2012-04-13 |
| 1306281373 | Michelle Karen Calandra | Registered Nurse | 1000 Michigan Ave, Charleston Afb, SC 29404-2020 | 2013-05-06 |
| 1336560440 | Merin Williams | Speech-Language Pathologist | 1000 Michigan Ave, Charleston Afb, SC 29404-2020 | 2013-12-17 |
| 1154884468 | Palmetto Pa Assist, LLC | Physician Assistant | 101 Lawson Dr # 103, Charleston, SC 29404-2121 | 2019-04-12 |
| 1750811089 | Radiant Neuromonitoring LLC | Psychiatry & Neurology | 101 Lawson Dr # 104, Charleston, SC 29404-2121 | 2017-06-19 |
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| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720221013 | Cristy Jo Preslar | Military Health Care Provider | 364 Arthur Drive, Charleston Afb, SC 29404 | 2009-04-16 |
| 1356871032 | Karina Cortes | Military Health Care Provider | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2017-06-15 |
| 1114261526 | Brett Randall | Military Health Care Provider | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2012-11-26 |
| 1417188137 | George James Antolick | Military Health Care Provider | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2009-07-29 |
| 1932339827 | Patricia L Sills | Military Health Care Provider | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2009-07-26 |
| 1477781045 | Jennifer B Cutlip | Military Health Care Provider | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2009-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770910788 | Heather Marie Phinney | Military Health Care Provider | 3345 Ashlynn Way, Sumter, SC 29154-8251 | 2013-10-04 |
| 1023380417 | John Becker | Military Health Care Provider | 134 Patriot Ln, Summerville, SC 29483-1889 | 2012-02-01 |
| 1770894966 | Kelli E. Vanpelt | Military Health Care Provider | 4023 Michigan Ave Apt B, Charleston, SC 29404-5541 | 2010-06-23 |
| 1689806291 | Jose L Pineiro | Military Health Care Provider | 437th Mdg, 204 West Hill Blvd, Charleston, SC 29404-4704 | 2009-08-14 |
| 1467687103 | Heather Nicole Eid | Military Health Care Provider | 5554 Whisperwood Dr, Dalzell, SC 29040-9670 | 2009-05-26 |
| 1396970117 | Jennifer N Steele | Military Health Care Provider | 411 Meadowlark St, Shaw A F B, SC 29152 | 2009-05-22 |
| 1588299457 | Albert Joseph Pendleton | Military Health Care Provider | 204 W Hill Blvd, Joint Base Charleston, SC 29404-4704 | 2020-03-11 |
| 1821631763 | Laura Simmons | Military Health Care Provider | 204 W Hill Blvd, Charleston, SC 29404-4704 | 2019-10-23 |
| 1205294550 | Brandon Stoker | Military Health Care Provider | 204 W Hill Blvd, Charleston, SC 29404-4704 | 2016-02-02 |
| 1285068296 | Sidonia Lee Alo | Military Health Care Provider | 431 Meadowlark St, Shaw Afb, SC 29152-5019 | 2013-08-27 |
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| City | CHARLESTON AFB |
| Zip Code | 29404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.