1659556603 NPI number — MICHAEL J. GOODWIN, MD, PSC

Table of content: (NPI 1659556603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659556603 NPI number — MICHAEL J. GOODWIN, MD, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL J. GOODWIN, MD, PSC
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:
1659556603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 ASHLAND DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101-7084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-325-0227
Provider Business Mailing Address Fax Number:
606-324-0126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 ASHLAND DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-325-0227
Provider Business Practice Location Address Fax Number:
606-324-0126
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOODWIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
606-325-0227

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  28576 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64285760 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0885350 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200012652 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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