Provider Demographics
NPI:1144764432
Name:GOOD HEALTH MEDICAL, PLLC
Entity Type:Organization
Organization Name:GOOD HEALTH MEDICAL, PLLC
Other - Org Name:MY DR NOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-677-8282
Mailing Address - Street 1:261 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2616
Mailing Address - Country:US
Mailing Address - Phone:480-305-2888
Mailing Address - Fax:
Practice Address - Street 1:1035 N ELLSWORTH RD
Practice Address - Street 2:108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-5144
Practice Address - Country:US
Practice Address - Phone:480-305-2888
Practice Address - Fax:480-535-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty