MEDICARE: WILLIAM SCOTT GOODE ATC

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	2255A2300X	Athletic Trainer	AT00207	RI

General Provider Information

NPI Number	:	1508851072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SCOTT GOODE ATC

Provider Business Mailing Address
First Line	:	33 MIDDLETON AVE
Second Line	:	APT 2
City	:	NEWPORT
State	:	RI
Zip	:	02840-3641
Country	:	US
Telephone Number	:	401-341-2065
Fax Number	:	401-341-2911

Provider Business Practice Location Address
First Line	:	9040A JACKSON AVE
Second Line	:
City	:	JOINT BASE LEWIS MCCHORD
State	:	WA
Zip	:	98431-4149
Country	:	US
Telephone Number	:	401-263-3747
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/27/2022

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