Provider Demographics
NPI:1881903151
Name:MICHAEL R GOODMAN MD PC
Entity type:Organization
Organization Name:MICHAEL R GOODMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-354-8025
Mailing Address - Street 1:9239 WEST CENTER ROAD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1968
Mailing Address - Country:US
Mailing Address - Phone:402-354-8025
Mailing Address - Fax:402-354-8044
Practice Address - Street 1:9239 WEST CENTER ROAD
Practice Address - Street 2:SUITE 221
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1968
Practice Address - Country:US
Practice Address - Phone:402-354-8025
Practice Address - Fax:402-354-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE180522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid
274461Medicare PIN
F01570Medicare UPIN