1497786073 NPI number — MICHAEL J. GOEDEN, MD, PC

Table of content: (NPI 1497786073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497786073 NPI number — MICHAEL J. GOEDEN, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL J. GOEDEN, MD, PC
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:
PRIME CARE URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1497786073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2511 SALEM CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22407-6466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-786-1200
Provider Business Mailing Address Fax Number:
540-786-3195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2511 SALEM CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22407-6466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-786-1200
Provider Business Practice Location Address Fax Number:
540-786-3195
Provider Enumeration Date:
07/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOEDEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
540-786-1200

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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