Provider Demographics
NPI:1265434443
Name:GOODMAN, SCOTT H (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:H
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4242 FARNAM ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2806
Mailing Address - Country:US
Mailing Address - Phone:402-552-2650
Mailing Address - Fax:402-552-2655
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2806
Practice Address - Country:US
Practice Address - Phone:402-552-2650
Practice Address - Fax:402-552-2655
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04298352084N0400X
MO20020256322084N0400X
IA383332084N0400X
NE251502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7364484OtherAETNA
MO10001648902OtherCOMMUNITY HEALTH PLAN
MO32772027OtherBLUE SHIELD
MOP00379248OtherMEDICARE RAILROAD
NE10025242300Medicaid
MO209017508Medicaid
MO7570195OtherCIGNA
MO32772027OtherBLUE SHIELD
MO10001648902OtherCOMMUNITY HEALTH PLAN
H18794Medicare UPIN
MO7570195OtherCIGNA