Provider Demographics
NPI:1942206941
Name:GOOD, THOMAS S (NP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
Last Name:GOOD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 E HARMONY RD
Mailing Address - Street 2:UNIT 100
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3401
Mailing Address - Country:US
Mailing Address - Phone:970-221-1000
Mailing Address - Fax:970-221-1544
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:UNIT 100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3401
Practice Address - Country:US
Practice Address - Phone:970-221-1000
Practice Address - Fax:970-221-1544
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO108964363LF0000X
NE60261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82475814Medicaid
CO490588Medicare ID - Type UnspecifiedPROVIDER ID
P84184Medicare UPIN
NE276623Medicare ID - Type UnspecifiedPROVIDER ID