Provider Demographics
NPI:1033383310
Name:GODSEY ENTERPRISES INC
Entity Type:Organization
Organization Name:GODSEY ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GODSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-282-1932
Mailing Address - Street 1:111 BROYLES ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2532
Mailing Address - Country:US
Mailing Address - Phone:423-282-1932
Mailing Address - Fax:423-282-8813
Practice Address - Street 1:111 BROYLES ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2532
Practice Address - Country:US
Practice Address - Phone:423-282-1932
Practice Address - Fax:423-282-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO174156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0926950001Medicare NSC