MEDICARE: JODI M CISCO-GOFF MD

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	208600000X	Surgery Physician	20768	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497714737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI M CISCO-GOFF MD

Provider Business Mailing Address
First Line	:	1600 MEDICAL CENTER DR
Second Line	:	SUITE 2500
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3656
Country	:	US
Telephone Number	:	304-691-1200
Fax Number	:	304-691-1287

Provider Business Practice Location Address
First Line	:	77 HOSPITAL DR
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-3451
Country	:	US
Telephone Number	:	304-792-1847
Fax Number	:	304-792-1849

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	12/03/2021

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Directions to “ JODI M CISCO-GOFF MD” Practice Location

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