Healthcare Provider Details

I. General information

NPI: 1609214733
Provider Name (Legal Business Name): GOODWIN AND GOODWIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 N DREXEL AVE
BEXLEY OH
43209-1046
US

IV. Provider business mailing address

548 N DREXEL AVE
BEXLEY OH
43209-1046
US

V. Phone/Fax

Practice location:
  • Phone: 740-972-3227
  • Fax:
Mailing address:
  • Phone: 740-972-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number2502581
License Number StateOH

VIII. Authorized Official

Name: MRS. AGGIE MOORER
Title or Position: PRESIDENT
Credential:
Phone: 740-972-3227