Provider Demographics
NPI:1487841912
Name:LINDA A. GOODRUM, M.D.,P.A.
Entity Type:Organization
Organization Name:LINDA A. GOODRUM, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-338-7693
Mailing Address - Street 1:251 MEDICAL CENTER BLVD STE 300A
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4242
Mailing Address - Country:US
Mailing Address - Phone:281-338-7693
Mailing Address - Fax:281-338-8849
Practice Address - Street 1:251 MEDICAL CENTER BLVD STE 300A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4242
Practice Address - Country:US
Practice Address - Phone:281-338-7693
Practice Address - Fax:281-338-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176589301Medicaid
TX132474109Medicaid
TXF82371Medicare UPIN
TX132474109Medicaid
TX8D4055Medicare PIN