Provider Demographics
NPI:1922144054
Name:NICOLE GOLDING, M.D., P.S.C.
Entity Type:Organization
Organization Name:NICOLE GOLDING, M.D., P.S.C.
Other - Org Name:NICOLE GOLDING & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-478-4797
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66601-0326
Mailing Address - Country:US
Mailing Address - Phone:785-354-4740
Mailing Address - Fax:785-233-2295
Practice Address - Street 1:1504 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1632
Practice Address - Country:US
Practice Address - Phone:785-232-8566
Practice Address - Fax:785-232-8572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430700208100000X
KS04-27948208100000X
KS15-00312363A00000X
KS15-01111363A00000X
KS1167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111063OtherBLUE CROSS BLUE SHIELD
KSDD5989OtherRAILROAD MEDICARE
KS111063OtherBLUE CROSS BLUE SHIELD