JOSE R PENA III (NPI# 1407346927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407346927 |
| Entity Type | Individual |
| Full Name | JOSE R PENA III |
| Credential | DO |
| Practice Address |
1600 Providence Dr Waco TX 76707-2261 |
| Practice Telephone | 2543134200 |
| Practice Fax Number | 2543134531 |
| Mailing Telephone | 2543134200 |
| Mailing Fax Number | 2543134531 |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2020-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | BP10063987 | TX | Allopathic & Osteopathic Physicians |
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
S3041 | TX | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820564 | Jose Manuel Pena | Behavior Technician | 69 Nw 45th Ave, Miami, FL 33126-5341 | 2020-10-26 |
| 1265081657 | Jose M Pena | Home Health Aide | 816 Florida St, San Antonio, TX 78210 | 2019-09-09 |
| 1457754392 | Jose Pena | Nurse Practitioner | 15641 Sw 8th Ln, Miami, FL 33194-2409 | 2014-10-07 |
| 1285889386 | Jose A Pena | Obstetrics & Gynecology | 4735 Ave Isla Verde, Apt 3d, Carolina, PR 00979-5442 | 2008-11-18 |
| 1205875721 | Jose Fernado Pena | Internal Medicine | 307 N Salinas Blvd, Donna, TX 78537-2929 | 2006-06-06 |
| 1982670931 | Jose Rolando Pena | Family Medicine | K2 Calle 4, Rio Grande, PR 00745-2823 | 2006-02-28 |
| 1770013583 | Jose Manuel Pena | Pediatrics | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2017-06-14 |
| 1134674112 | Jose Pena | Counselor | 730 Medical Center Ct, Chula Vista, CA 91911-6618 | 2016-08-19 |
| 1871942359 | Jose Martin Pena | Pharmacist | 200 Fairmont Shopping Ctr, Pacifica, CA 94044-1240 | 2016-06-06 |
| 1144674078 | Jose Pena | Specialist/Technologist | 103 E 3rd St, Unit A, Arlington, TX 76010-7388 | 2016-04-18 |
| Street Address |
1600 PROVIDENCE DR |
| City | WACO |
| State | TX |
| Zip Code | 76707-2261 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912900531 | Matthew Rafalski | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2005-05-27 |
| 1083228621 | Jourdan Brown Whorley | Physician Assistant | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-09-01 |
| 1538778543 | Hilda Ana Deen | Nurse Practitioner | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-07-26 |
| 1427673128 | Allison Dawn Thompson | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
| 1245855949 | Thien Phu Nguyen | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
| 1134744824 | William Casey Dean | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
| 1306461090 | Corey Ryan Holt | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
| 1821613514 | Kathryn Leah Kline | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
| 1346865037 | Michael Thomas Boone | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
| 1295350999 | Amanda Elizabeth Weaver | Family Medicine | 1600 Providence Dr, Waco, TX 76707-2261 | 2020-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588184493 | Yukiyo Shimosawa | Specialist/Technologist | 1010 N 17th St, Waco, TX 76707 | 2017-06-21 |
| 1851730022 | Krystal Ann Estrada | Family Medicine | 1600 Providence Drive, Waco, TX 76707 | 2013-06-20 |
| 1598902744 | Narconon Hawaii | Substance Abuse Rehabilitation Facility | 90-1011 Lexington Avenue, Kapolei, HI 76707 | 2009-01-09 |
| 1851413520 | Albert Bryan Lewter Jr. | Dentist | 1501 N 25th St, Waco, TX 76707 | 2007-04-04 |
| 1114010733 | Remmel Henry | Dentist | 225 W. West Waco Dr., Waco, TX 76707 | 2006-10-02 |
| 1861831034 | Ryan David Laschober | Family Medicine | 1600 Providence Drive, Waco, TX 76707 | 2013-06-20 |
| 1760821946 | Brandi Escalante Street | Family Medicine | 1600 Providence Drive, Waco, TX 76707 | 2013-06-20 |
| 1972778199 | Jason Craig | Counselor | 3621 Lasker Ave, Waco, TX 76707-1111 | 2008-04-29 |
| 1649831298 | Melanie Adams | Social Worker | 3617 Maple Ave, Waco, TX 76707-1117 | 2019-06-25 |
| 1538721246 | Jessica Marie Simon | Nurse Practitioner | 3613 Trice Ave, Waco, TX 76707-1127 | 2019-07-02 |
| Find all providers in zip 76707 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215586532 | Salvation' International Mission | Family Medicine | 1341 County Road 557, Farmersville, TX 75442-7081 | 2019-09-09 |
| 1598036642 | James Thomas Payte | Family Medicine | 260 Panther Xing, Wimberley, TX 78676-5767 | 2012-01-21 |
| 1255535829 | Karen Quintavell Radcliffe | Family Medicine | 201 Enterprise Avenue, Suite 800, League City, TX 77573 | 2007-06-14 |
| 1710037023 | Candace Freeman Mcdaniel | Family Medicine | 8021 East R. L. Thornton Frwy, Suite A, Dallas, TX 75228 | 2007-01-11 |
| 1831246842 | Jeffrey L Butts | Family Medicine | 37131 Interstate 10 W, Suite 101, Boerne, TX 78006-8989 | 2007-01-04 |
| 1942373816 | Texas Avenue Medical Clinic | Family Medicine | 1703 E 29th Street, Bryan, TX 77802 | 2006-11-16 |
| 1881783413 | Edward P Tyson | Family Medicine | 3811 Bee Caves Rd, Ste 200, Austin, TX 78746-6459 | 2006-10-12 |
| 1780693911 | Robert M. Leath | Family Medicine | 3033 North Gessner Drive, Suite 1106, Houston, TX 77080 | 2006-08-05 |
| 1639114176 | Samuel B. Ganz | Family Medicine | 13509 Camino De Plata Ct, Corpus Christi, TX 78418-6966 | 2006-06-18 |
| 1255329694 | Katherine H Thompson | Family Medicine | 6300 Richmond Ave, Houston, TX 77057 | 2005-10-10 |
| 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.