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NPI Code Detail

MEDICARE: SAMUEL DENTON GOODE

MEDICARE: SAMUEL DENTON GOODE
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
1106S00000XBehavior TechnicianRBT-24-359246MO

General Provider Information

NPI Number : 1720824238
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL DENTON GOODE
Provider Business Mailing Address
First Line : 1100 E PORTLAND ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-1870
Country : US
Telephone Number : 417-920-7199
Fax Number :
Provider Business Practice Location Address
First Line : 500 W DANIELS ST
Second Line :
City : OZARK
State : MO
Zip : 65721-7322
Country : US
Telephone Number : 417-719-2057
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2024
Last Update Date : 07/03/2024

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Directions to “ SAMUEL DENTON GOODE ” Practice Location

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