Provider Demographics
NPI:1669511101
Name:GOODE, LOIS LOUISE (MS, PT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:LOUISE
Last Name:GOODE
Suffix:
Gender:F
Credentials:MS, PT, OCS, ATC
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 1420
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-1420
Mailing Address - Country:US
Mailing Address - Phone:928-536-2357
Mailing Address - Fax:928-536-2385
Practice Address - Street 1:200 HOSPITAL DRIVE
Practice Address - Street 2:WHITERIVER SERVICE UNIT
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941-0860
Practice Address - Country:US
Practice Address - Phone:928-338-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8HC881Medicare ID - Type UnspecifiedMEDICARE B WHITERIVER