Organization · NPI-2
Goodside Health Medical, PLLC
Pediatrics · Rocky River, OH
NPI number1699404541
StatusActive
Last updated in NPPESJul 1, 2022
Details
- NPI
- 1699404541
- Entity type
- Organization (NPI-2)
- Legal business name
- Goodside Health Medical, PLLC
- Organization subpart
- No
- Enumeration date
- Jun 7, 2022
- Certification date
- Jul 1, 2022
- Last updated
- Jul 1, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | – | – | Yes |
| 207Q00000X | Family Medicine | – | – | |
| 207R00000X | Internal Medicine | – | – | |
| 261Q00000X | Clinic/Center | – | – | |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | |
| 363A00000X | Physician Assistant | – | – | |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
20575 Center Ridge Rd Ste 112Rocky River, OH 44116-3422
Phone 281-203-5006
Mailing address
1701 River Run Ste 302Fort Worth, TX 76107-6547
Phone 281-203-5006
Authorized official
Gerardo Reyes
Owner
2812035006
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