Healthcare Provider Details

I. General information

NPI: 1811594476
Provider Name (Legal Business Name): WILLIAM H GOODSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2288 TATMAN COE RD
MC DERMOTT OH
45652-8902
US

IV. Provider business mailing address

PO BOX 265
LUCASVILLE OH
45648-0265
US

V. Phone/Fax

Practice location:
  • Phone: 740-340-8826
  • Fax:
Mailing address:
  • Phone: 740-250-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: