Provider Demographics
NPI:1235229220
Name:GOODMAN & BROOKS FAMILY PRACTICE ASSOCIATES, PA
Entity Type:Organization
Organization Name:GOODMAN & BROOKS FAMILY PRACTICE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LINGLE
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-304-0840
Mailing Address - Street 1:2820 16TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9600
Mailing Address - Country:US
Mailing Address - Phone:828-304-0840
Mailing Address - Fax:828-304-0943
Practice Address - Street 1:2820 16TH ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9600
Practice Address - Country:US
Practice Address - Phone:828-304-0840
Practice Address - Fax:828-304-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012JEMedicaid
NC89012JEMedicaid
NCCB6965Medicare PIN