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General NPI Number Information
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NPI Number | 1104028489
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Entity Type | Organization
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Legal Business Name | GOODMAN MEDICAL CENTER PC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 715 STATE ROUTE CC
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City | ROLLA
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State | MO
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Zip | 65401-4402
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Country | US
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Telephone | 573-308-5044
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Fax | 573-341-5300
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Provider Business Mailing Address
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Address Line | PO BOX 918
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City | ROLLA
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State | MO
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Zip | 65402-0918
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Country | US
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Telephone | 573-308-5044
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Fax | 573-341-5300
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Authorized Official
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Title or Position | COOWNER
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Name | MRS. KARENE MARIE GOODMAN
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Credential | NP
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Telephone | 573-308-5044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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