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General NPI Number Information
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NPI Number | 1619370426
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Entity Type | Organization
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Legal Business Name | GOOD YEARS FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 14960 W INDIAN SCHOOL RD SUITE 340
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City | GOODYEAR
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State | AZ
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Zip | 85395-7814
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Country | US
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Telephone | 623-594-3171
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Fax | 623-594-3161
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Provider Business Mailing Address
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Address Line | 10240 W INDIAN SCHOOL RD SUITE 155
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City | PHOENIX
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State | AZ
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Zip | 85037-5904
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Country | US
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Telephone | 623-594-3171
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Fax | 623-594-3161
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY K CHROSTOWSKI
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Credential | M.D.
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Telephone | 623-594-3171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 31975
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License Number State | AZ
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