Provider Demographics
NPI:1154956019
Name:GOODWILL DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:GOODWILL DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMELINE
Authorized Official - Middle Name:ENO
Authorized Official - Last Name:AKUTA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:347-200-6741
Mailing Address - Street 1:19618 HERITAGE ELM CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4390
Mailing Address - Country:US
Mailing Address - Phone:877-469-9990
Mailing Address - Fax:281-596-6908
Practice Address - Street 1:19618 HERITAGE ELM CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-4390
Practice Address - Country:US
Practice Address - Phone:877-469-9990
Practice Address - Fax:281-596-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty