MR. MATTHEW LEE PENSE (NPI# 1144490202) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144490202 |
| Entity Type | Individual |
| Full Name | MR. MATTHEW LEE PENSE |
| Credential | IDEPENDENT DUTY CORP |
| Practice Address |
814 Radford Blvd Albany GA 31704-9998 |
| Mailing Address |
814 Radford Blvd Albany GA 31704-1130 |
| Practice Telephone | 2296397886 |
| Mailing Telephone | 2296397886 |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2008-03-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | Other Service Providers |
| Street Address |
814 RADFORD BLVD |
| City | ALBANY |
| State | GA |
| Zip Code | 31704-9998 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740269166 | Chidiebere Uzoma Ekenna-kalu | Optometrist | 814 Radford Blvd, Bldg 7000, Albany, GA 31704-1130 | 2006-01-13 |
| 1952761959 | John David Pascual | Military Health Care Provider | 814 Radford Blvd, Bldg 7000, Albany, GA 31704-1130 | 2016-03-03 |
| 1053665018 | Barbara M Robinson | Pharmacist | 814 Radford Blvd, Building 7000, Albany, GA 31704-4021 | 2012-10-30 |
| 1598064289 | Marine Corps Logistics Base Albany, Ga | Ambulance | 814 Radford Blvd, Suite 20346, Albany, GA 31704-1130 | 2011-03-21 |
| 1245416585 | Ryan Edward Sanford | Military Health Care Provider | 814 Radford Blvd, 20328, Albany, GA 31704-1130 | 2008-01-17 |
| 1588845762 | James Reginald Wyche | Military Health Care Provider | 814 Radford Blvd, Suite 20328, Albany, GA 31704-1130 | 2007-11-16 |
| 1952591034 | Patricia Montgomery | Nurse Practitioner | 814 Radford Blvd, Albany, GA 31704-1130 | 2007-07-26 |
| 1285731034 | Naval Hospital Jacksonville | Military/U.S. Coast Guard Pharmacy | 814 Radford Blvd, Bldg 7200, Albany, GA 31704-5000 | 2006-09-20 |
| 1316997026 | Dublin Vamc | Clinic/Center | 814 Radford Blvd, Albany, GA 31704-1130 | 2006-05-11 |
| 1952374514 | Wendell Eugene Lovett | Pharmacist | 814 Radford Blvd, Bldg 7200, Albany, GA 31705-9911 | 2006-02-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033639752 | Ryan Charles Romer | Military Health Care Provider | 814 Radford Blvd Ste 20328, Albany, GA 31704-1130 | 2017-06-23 |
| 1992212112 | Laketa Clyde Williams | Social Worker | 814 Radford Blvd Bldg 7000, Albany, GA 31704-1130 | 2018-01-09 |
| 1952816811 | Branch Medical Clinic Albany | Clinic/Center | 814 Radford Blvd Bldg 7000, Albany, GA 31704-1130 | 2017-12-13 |
| 1437561214 | Branch Medical Clinic Albany Pharmacy | Military/U.S. Coast Guard Pharmacy | 814 Radford Blvd Bldg 7000, Marine Corps Logistics Base, Albany, GA 31704-1130 | 2014-05-28 |
| 1508045550 | Hubert Williams | Military Health Care Provider | 814 Radford Blvd Bldg 7000, Albany, GA 31704-9998 | 2007-10-26 |
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700425568 | Greggory Theotis Kent | Military Health Care Provider | 223 E Grady Ave, Lyons, GA 30436-1509 | 2019-12-26 |
| 1083142947 | Integrative Cap Health Practices | Military Health Care Provider | 770 Old Roswell Pl Ste G400, Roswell, GA 30076-8635 | 2017-05-23 |
| 1972037323 | Alicia Anderson | Military Health Care Provider | 621 Mcgruder St. Ne, Atlanta, GA 30312 | 2017-04-12 |
| 1508227141 | Compassion Community PCh LLC | Military Health Care Provider | 1942 Appling Harlem Rd, Appling, GA 30802-3723 | 2016-03-09 |
| 1982063749 | Mallori Tittle | Military Health Care Provider | 6254 Warm Springs Rd Apt G6, Columbus, GA 31909-9152 | 2016-02-22 |
| 1902243876 | Victor D Parker IIi | Military Health Care Provider | 78th Medical Group Sghc, 655 Seventh Street, Robins Afb, GA 31098 | 2013-05-31 |
| 1235575325 | Gerardo Julian Soracco | Military Health Care Provider | 4415 Northside Chase Nw, Atlanta, GA 30327-3567 | 2013-05-15 |
| 1790023406 | Donna Sue Muller | Military Health Care Provider | 2715 Cosmos Dr Ne, Atlanta, GA 30345-1307 | 2013-01-30 |
| 1316298144 | Sandra Diane Tyree | Military Health Care Provider | 6490 Clyattstone Rd, Hahira, GA 31632-3112 | 2012-09-19 |
| 1558643536 | Eleanor S. Lee | Military Health Care Provider | 4211 Misty Morning Way, #2319, Gainesville, GA 30506-4347 | 2011-09-15 |
| Find all providers with the same taxonomy | ||||
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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.