MEDICARE: ROGER M GOOS PLMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	7854	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	202584413	OTHER	NE	MIDLANDS CHOICE

General Provider Information

NPI Number	:	1205991718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER M GOOS PLMHP

Provider Business Mailing Address
First Line	:	3002 39TH ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-1656
Country	:	US
Telephone Number	:	402-564-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	3314 26TH ST
Second Line	:	STE A
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2304
Country	:	US
Telephone Number	:	402-564-9888
Fax Number	:	402-564-9899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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Directions to “ ROGER M GOOS PLMHP” Practice Location

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