Provider Demographics
NPI:1689761934
Name:GOODHEALTH MEDICAL PRODUCTS, INC
Entity Type:Organization
Organization Name:GOODHEALTH MEDICAL PRODUCTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYCEE
Authorized Official - Middle Name:T
Authorized Official - Last Name:EKUFU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-737-9005
Mailing Address - Street 1:2621 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1708
Mailing Address - Country:US
Mailing Address - Phone:773-737-9005
Mailing Address - Fax:773-737-9012
Practice Address - Street 1:2621 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1708
Practice Address - Country:US
Practice Address - Phone:773-737-9005
Practice Address - Fax:773-737-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000439332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633204OtherILLINOIS BLUE CROSS BS
IL0001633204OtherILLINOIS BLUE CROSS BS
IL=========001Medicaid