Provider Demographics
NPI:1851513170
Name:HENRY C. GOODMAN, M.D. PSC
Entity Type:Organization
Organization Name:HENRY C. GOODMAN, M.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-329-2823
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2823
Mailing Address - Country:US
Mailing Address - Phone:606-329-2823
Mailing Address - Fax:606-324-6291
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2823
Practice Address - Country:US
Practice Address - Phone:606-329-2823
Practice Address - Fax:606-324-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439869Medicaid
KY64238900Medicaid
OH0439869Medicaid
KY6180390001Medicare NSC
KY1404901Medicare PIN