Provider Demographics
NPI:1619370426
Name:GOOD YEARS FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:GOOD YEARS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHROSTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-594-3171
Mailing Address - Street 1:10240 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5904
Mailing Address - Country:US
Mailing Address - Phone:623-594-3171
Mailing Address - Fax:623-594-3161
Practice Address - Street 1:14960 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 340
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7814
Practice Address - Country:US
Practice Address - Phone:623-594-3171
Practice Address - Fax:623-594-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31975261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service