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General NPI Number Information
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NPI Number | 1053111948
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Entity Type | Organization
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Legal Business Name | GOE IPA, INC.
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 6805 US HIGHWAY 11
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City | POTSDAM
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State | NY
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Zip | 13676-3131
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Country | US
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Telephone | 315-265-3105
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Fax |
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Provider Business Mailing Address
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Address Line | 6805 US HIGHWAY 11
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City | POTSDAM
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State | NY
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Zip | 13676-3131
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Country | US
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Telephone | 315-265-3105
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Fax |
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Authorized Official
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Title or Position | BOARD SECRETARY
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Name | RUTH FISHBECK
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Credential |
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Telephone | 315-265-3105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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