RONNIE LEE GODBOLT IDMT
NPI 1104054659
Military Health Care Provider - Independent Duty Medical Technicians in Charleston Afb, SC

Active since June 23, 2009
204 W HILL BLVD, CHARLESTON AFB, SC 29404(843) 963-6936(843) 963-6903 Get Directions Write a Review

NPPES record last updated: June 23, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ronnie Lee Godbolt Idmt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RONNIE LEE GODBOLT IDMT (NPI 1104054659) is an individual independent duty medical technicians provider in Charleston Afb, South Carolina and active in the NPI registry since June 2009.

NPPES Registry Identity

NPI1104054659
Entity TypeIndividualMale
Primary Taxonomy1710I1003X
Provider Legal NameRONNIE LEE GODBOLTCredential: IDMT
Location Address204 W HILL BLVDCharleston Afb, SC 29404-4704
Mailing Address204 W Hill BlvdCharleston Afb, SC 29404-4704 · (843) 963-6936 · Fax (843) 963-6903
Fax(843) 963-6903
Sole ProprietorNo
Enumeration DateJune 23, 2009
NPI 1104054659 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code1710I1003X
Definition
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.
204 W HILL BLVD, Charleston Afb, SC 29404

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Clinic/Center
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Social Worker (Clinical)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Family Medicine
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Pharmacist
204 W HILL BLVD, 628TH MEDICAL GROUP
CHARLESTON AFB, SC 29404
Social Worker (Clinical)
204 W HILL BLVD
JOINT BASE CHARLESTON, SC 29404
Social Worker (Clinical)
204 W HILL BLVD
JOINT BASE CHARLESTON, SC 29404
Preventive Medicine (Aerospace Medicine)
204 W HILL BLVD
CHARLESTON AFB, SC 29404
Dentist (General Practice)
204 W HILL BLVD, 628TH MEDICAL GROUP DENTAL SERVICES
CHARLESTON AFB, SC 29404

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ronnie Godbolt's NPI number?

The NPI number for Ronnie Godbolt is 1104054659. It was assigned to this individual provider in the NPPES registry on June 23, 2009.

Where is Ronnie Godbolt located?

Ronnie Godbolt practices at 204 W Hill Blvd, Charleston Afb, SC 29404. The listed phone number is (843) 963-6936.

What is Ronnie Godbolt's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Medical Technicians, with taxonomy code 1710I1003X.

When was this NPI record last updated?

The NPPES record for Ronnie Godbolt was last updated on June 23, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.