Provider Demographics
NPI:1578570180
Name:GOODRICH, STACEY D (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:D
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0538
Mailing Address - Country:US
Mailing Address - Phone:402-335-2811
Mailing Address - Fax:402-335-2826
Practice Address - Street 1:202 HIGH ST STE 100
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-2443
Practice Address - Country:US
Practice Address - Phone:402-335-2811
Practice Address - Fax:402-335-2826
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE17-89553OtherUHC
NE3558OtherMIDLAND'S CHOICE
NE00060OtherBCBS
NE3558OtherMIDLAND'S CHOICE
NE00060OtherBCBS
NE281224Medicare PIN