Provider Demographics
NPI:1255017232
Name:GOSHEN MEDICAL HOUSECALL PLLC
Entity type:Organization
Organization Name:GOSHEN MEDICAL HOUSECALL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:CORDILIA
Authorized Official - Last Name:EGEDE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:469-358-5195
Mailing Address - Street 1:905 BELCLAIRE CIR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1237
Mailing Address - Country:US
Mailing Address - Phone:469-358-5195
Mailing Address - Fax:
Practice Address - Street 1:150 E HIGHWAY 67 STE 180
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-4476
Practice Address - Country:US
Practice Address - Phone:469-358-5195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care