Provider Demographics
NPI:1245514959
Name:JOHN E. GOFF, MD PC
Entity type:Organization
Organization Name:JOHN E. GOFF, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-782-3600
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64802-1646
Mailing Address - Country:US
Mailing Address - Phone:417-782-3600
Mailing Address - Fax:417-782-2734
Practice Address - Street 1:104 S MAIN
Practice Address - Street 2:
Practice Address - City:CARL JUNCTION
Practice Address - State:MO
Practice Address - Zip Code:64834
Practice Address - Country:US
Practice Address - Phone:417-782-3600
Practice Address - Fax:417-782-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7320305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201136603Medicaid
MO201136603Medicaid
MO000004629Medicare PIN