Provider Demographics
NPI:1558444133
Name:GOODSPEED, TONYA (MD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TONYA
Other - Middle Name:R G
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 MICHIGAN AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1580
Mailing Address - Country:US
Mailing Address - Phone:574-722-4921
Mailing Address - Fax:574-739-0520
Practice Address - Street 1:1201 MICHIGAN AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1580
Practice Address - Country:US
Practice Address - Phone:574-722-4921
Practice Address - Fax:574-739-0520
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052818A207QH0002X
IN01052818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200402320Medicaid
INP01428204OtherRR MEDICARE
IN000000915720OtherANTHEM
IN940670030Medicare PIN
IN151560J5Medicare PIN
IN200402320Medicaid