Provider Demographics
NPI:1750995643
Name:DIANE GOETZ FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:DIANE GOETZ FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOETZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:270-215-7744
Mailing Address - Street 1:3000 ALVEY PARK DR W STE D
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4099
Mailing Address - Country:US
Mailing Address - Phone:270-215-7744
Mailing Address - Fax:
Practice Address - Street 1:3000 ALVEY PARK DR W STE D
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4099
Practice Address - Country:US
Practice Address - Phone:270-215-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty