Provider Demographics
NPI:1821270406
Name:GOODWIN FOOT & ANKLE CENTER PLLC
Entity Type:Organization
Organization Name:GOODWIN FOOT & ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-905-0590
Mailing Address - Street 1:PO BOX 6130
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0711
Mailing Address - Country:US
Mailing Address - Phone:304-905-0590
Mailing Address - Fax:304-905-9458
Practice Address - Street 1:3500 JACOB ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-1934
Practice Address - Country:US
Practice Address - Phone:304-905-0590
Practice Address - Fax:304-905-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00377213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012712Medicaid
WV6083730001Medicare NSC
WV9373831Medicare PIN