Provider Demographics
NPI:1780653725
Name:WAYNE F. GOODRICH
Entity type:Organization
Organization Name:WAYNE F. GOODRICH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-292-1971
Mailing Address - Street 1:2301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4338
Mailing Address - Country:US
Mailing Address - Phone:800-292-1971
Mailing Address - Fax:517-372-1200
Practice Address - Street 1:2301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4338
Practice Address - Country:US
Practice Address - Phone:800-292-1971
Practice Address - Fax:517-372-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies