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NPI Code Detail

MEDICARE: MARY E GOOD PA-C

MEDICARE: MARY E GOOD PA-C
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
1363A00000XPhysician Assistant5601002600MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970016336OTHERMIRAILROAD MEDICARE

General Provider Information

NPI Number : 1609805001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E GOOD PA-C
Provider Business Mailing Address
First Line : 9625 RED ARROW HWY
Second Line :
City : BRIDGMAN
State : MI
Zip : 49106-9559
Country : US
Telephone Number : 269-465-6050
Fax Number : 269-465-3134
Provider Business Practice Location Address
First Line : 9625 RED ARROW HWY
Second Line :
City : BRIDGMAN
State : MI
Zip : 49106-9559
Country : US
Telephone Number : 269-465-6050
Fax Number : 269-465-3134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 03/14/2013

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Directions to “ MARY E GOOD PA-C” Practice Location

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