Provider Demographics
NPI:1003051657
Name:MARSHA E GOODHEAD MD PC
Entity Type:Organization
Organization Name:MARSHA E GOODHEAD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHENCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-731-4215
Mailing Address - Street 1:3201 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2441
Mailing Address - Country:US
Mailing Address - Phone:702-731-4215
Mailing Address - Fax:702-369-9843
Practice Address - Street 1:3201 S MARYLAND PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2441
Practice Address - Country:US
Practice Address - Phone:702-731-4215
Practice Address - Fax:702-369-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4023207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1437119435Medicaid
NV1437119435OtherINDIVIDUAL NPI NUMBER