Healthcare Provider Details

I. General information

NPI: 1285838771
Provider Name (Legal Business Name): GOODALE VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 N NAVARRO ST STE L
VICTORIA TX
77901-3937
US

IV. Provider business mailing address

2806 N NAVARRO ST STE L
VICTORIA TX
77901-3937
US

V. Phone/Fax

Practice location:
  • Phone: 361-575-9911
  • Fax: 361-575-9977
Mailing address:
  • Phone: 361-575-9911
  • Fax: 361-575-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number50652
License Number StateTX

VIII. Authorized Official

Name: SHARON D. GOODALE
Title or Position: PRESIDENT
Credential: BS-HIS
Phone: 361-575-9911