Provider Demographics
NPI:1619260395
Name:GOODWIN MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:GOODWIN MEDICAL GROUP, PLLC
Other - Org Name:MOORE EXPRESS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:B
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:405-250-8441
Mailing Address - Street 1:9750 CHLOE LN
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-7008
Mailing Address - Country:US
Mailing Address - Phone:405-250-8441
Mailing Address - Fax:
Practice Address - Street 1:2020 SOUTH SERVICE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160
Practice Address - Country:US
Practice Address - Phone:405-250-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care