Provider Demographics
NPI:1174948434
Name:THOMAS F. GOODALL, D. O., INC.
Entity type:Organization
Organization Name:THOMAS F. GOODALL, D. O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:GOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-723-3525
Mailing Address - Street 1:425 W GRAND AVE
Mailing Address - Street 2:SUITE 3003
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4775
Mailing Address - Country:US
Mailing Address - Phone:937-226-7890
Mailing Address - Fax:937-461-4156
Practice Address - Street 1:425 W GRAND AVE
Practice Address - Street 2:SUITE 3003
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4775
Practice Address - Country:US
Practice Address - Phone:937-226-7890
Practice Address - Fax:937-461-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002454207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457858Medicaid
000000070362OtherANTHEM
123879100OtherFEDERAL BWC
0620007OtherUNITED HEALTHCARE
KY64044050Medicaid
OH0457858Medicaid
OHA80054Medicare UPIN