Provider Demographics
NPI:1255365185
Name:GOODALE MEDICAL LP
Entity type:Organization
Organization Name:GOODALE MEDICAL LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FARNSWORTH
Authorized Official - Last Name:GOODALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-328-0019
Mailing Address - Street 1:2614 INDUSTRIAL LN STE B
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2614 INDUSTRIAL LN STE B
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-2365
Practice Address - Country:US
Practice Address - Phone:214-932-6202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0011294332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14638901Medicaid
TX14638901Medicaid