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General NPI Number Information
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NPI Number | 1942348198
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Entity Type | Organization
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Legal Business Name | GOODMAN LOSTUTTER LLC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 607 WILSON CREEK RD
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City | LAWRENCEBURG
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State | IN
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Zip | 47025-1074
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Country | US
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Telephone | 812-537-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 607 WILSON CREEK RD
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City | LAWRENCEBURG
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State | IN
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Zip | 47025-1074
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Country | US
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Telephone | 812-537-4422
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LORI POE
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Credential |
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Telephone | 812-537-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 060011421
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License Number State | IN
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