Provider Demographics
NPI:1295839413
Name:GOODE 2 FEET
Entity Type:Organization
Organization Name:GOODE 2 FEET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GOODE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:434-348-3130
Mailing Address - Street 1:6109 HOLYOAKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-5717
Mailing Address - Country:US
Mailing Address - Phone:434-348-3130
Mailing Address - Fax:804-745-3468
Practice Address - Street 1:425 S MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-2300
Practice Address - Country:US
Practice Address - Phone:434-348-3130
Practice Address - Fax:804-745-3468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1847344OtherCIGNA
VA278060OtherMAMSI
VA278060OtherALLIANCE
VA6298858OtherGHI
VA7956331OtherAETNA
VA210584OtherSOUTHERN HEALTH
VA454380OtherANTHEM
VA9303502Medicaid
VAC08538Medicare PIN
VA278060OtherALLIANCE
VA210584OtherSOUTHERN HEALTH
VA278060OtherMAMSI