MEDICARE: MR. GODDY E ORGOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor	554000	LA

General Provider Information

NPI Number	:	1285959031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GODDY E ORGOR

Provider Business Mailing Address
First Line	:	3032 JACKSON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4743
Country	:	US
Telephone Number	:	713-446-6221
Fax Number	:	713-893-6018

Provider Business Practice Location Address
First Line	:	3032 JACKSON ST
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-4743
Country	:	US
Telephone Number	:	713-446-6221
Fax Number	:	713-893-6018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	04/05/2010

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Directions to “ MR. GODDY E ORGOR ” Practice Location

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