MEDICARE: MR. BENNIE GOGGANS JR.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	385H00000X	Respite Care
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1780365429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENNIE GOGGANS JR.

Provider Business Mailing Address
First Line	:	24520 RANDOLPH RD
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-3941
Country	:	US
Telephone Number	:	216-346-8212
Fax Number	:

Provider Business Practice Location Address
First Line	:	24520 RANDOLPH RD
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-3941
Country	:	US
Telephone Number	:	216-346-8212
Fax Number	:

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

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/26/2023

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Directions to “ MR. BENNIE GOGGANS JR. ” Practice Location

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