Provider Demographics
NPI:1235154246
Name:GOEKING, CHARLES KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEITH
Last Name:GOEKING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 HEARTLAND RD
Mailing Address - Street 2:SUITE 2800
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-6200
Mailing Address - Country:US
Mailing Address - Phone:816-271-1395
Mailing Address - Fax:816-271-1217
Practice Address - Street 1:901 HEARTLAND RD
Practice Address - Street 2:SUITE 2800
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6200
Practice Address - Country:US
Practice Address - Phone:816-271-1395
Practice Address - Fax:816-271-1217
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1B80207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
138418OtherHEALTHLINK
MO201507803Medicaid
MO465445OtherCHILDRENS MERCY FAMILY HEALTH
10001058601OtherCOMMUNITY HEALTH PLAN
KS100142990BMedicaid
602290OtherFIRSTGUARD
44054528964506V015OtherTRICARE/CHAMPUS
08853026OtherBLUE CROSS BLUE SHIELD
4535018OtherAETNA
P00036087OtherRR MEDICARE
602290OtherFIRSTGUARD
10001058601OtherCOMMUNITY HEALTH PLAN