Provider Demographics
NPI:1063574564
Name:PAUL L. GOEHRING DPM
Entity type:Organization
Organization Name:PAUL L. GOEHRING DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-846-0600
Mailing Address - Street 1:101 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1241
Mailing Address - Country:US
Mailing Address - Phone:724-846-0600
Mailing Address - Fax:724-846-7535
Practice Address - Street 1:101 DAVIS ST
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1241
Practice Address - Country:US
Practice Address - Phone:724-846-0600
Practice Address - Fax:724-846-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003497L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012168660003Medicaid
PAU03131Medicare UPIN
PA0012168660003Medicaid
PAGO629333Medicare ID - Type Unspecified