Provider Demographics
NPI:1659556603
Name:MICHAEL J. GOODWIN, MD, PSC
Entity type:Organization
Organization Name:MICHAEL J. GOODWIN, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-325-0227
Mailing Address - Street 1:1000 ASHLAND DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7084
Mailing Address - Country:US
Mailing Address - Phone:606-325-0227
Mailing Address - Fax:606-324-0126
Practice Address - Street 1:1000 ASHLAND DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7084
Practice Address - Country:US
Practice Address - Phone:606-325-0227
Practice Address - Fax:606-324-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28576207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64285760Medicaid
OH0885350Medicaid
200012652OtherRAILROAD MEDICARE
1535701Medicare PIN
KY64285760Medicaid
0309900001Medicare NSC