1992020366 NPI number — MARY S. GOSWITZ MD, PA

Table of content: (NPI 1992020366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992020366 NPI number — MARY S. GOSWITZ MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY S. GOSWITZ MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992020366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1297
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77522-1297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-420-8557
Provider Business Mailing Address Fax Number:
281-427-2911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4021 GARTH RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-420-8557
Provider Business Practice Location Address Fax Number:
281-427-2911
Provider Enumeration Date:
03/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOSWITZ
Authorized Official First Name:
MARY
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-420-8557

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  J6972 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018GK . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103039703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10017453 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".




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