Goodside Health Medical, PLLC
Pediatrics in Albuquerque, NM. Organization (NPI-2).
NPI number1033972716
StatusActive
Last updated in NPPESJun 13, 2024
Details
- NPI
- 1033972716
- Entity type
- Organization (NPI-2)
- Legal business name
- Goodside Health Medical, PLLC
- Organization subpart
- No
- Enumeration date
- Feb 5, 2024
- Certification date
- Mar 7, 2024
- Last updated
- Jun 13, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | – | – | Yes |
| 207R00000X | Internal Medicine | – | – | |
| 261Q00000X | Clinic/Center | – | – | |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | |
| 363A00000X | Physician Assistant | – | – | |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
9910 Indian School Rd Ne Ste 204Albuquerque, NM 87112-2971
Phone 512-884-5190
Mailing address
1701 River Run Ste 302Fort Worth, TX 76107-6547
Authorized official
Brian White
Ceo
8172440101
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