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General NPI Number Information
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NPI Number | 1124679436
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Entity Type | Organization
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Legal Business Name | DOCTORS GOODWILL FOUNDATION, INC
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 123 S PARK AVE
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City | TITUSVILLE
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State | FL
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Zip | 32796-3377
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Country | US
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Telephone | 321-567-4869
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Fax | 321-567-4874
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Provider Business Mailing Address
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Address Line | 3 INDIAN RIVER AVE APT 1001
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City | TITUSVILLE
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State | FL
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Zip | 32796-5821
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Country | US
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Telephone | 321-298-5531
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KANTILAL BHALANI
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Credential | MD
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Telephone | 321-298-5531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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