Healthcare Provider Details

I. General information

NPI: 1053111948
Provider Name (Legal Business Name): GOE IPA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 US HIGHWAY 11
POTSDAM NY
13676-3131
US

IV. Provider business mailing address

6805 US HIGHWAY 11
POTSDAM NY
13676-3131
US

V. Phone/Fax

Practice location:
  • Phone: 315-265-3105
  • Fax:
Mailing address:
  • Phone: 315-265-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RUTH FISHBECK
Title or Position: BOARD SECRETARY
Credential:
Phone: 315-265-3105