Provider Demographics
NPI:1386071207
Name:MIDWEST NEUROPSYCHOLOGICAL CONSULTANT
Entity type:Organization
Organization Name:MIDWEST NEUROPSYCHOLOGICAL CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOFFINET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-402-5625
Mailing Address - Street 1:101 N PLAZA EAST BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2804
Mailing Address - Country:US
Mailing Address - Phone:812-402-5625
Mailing Address - Fax:812-402-5627
Practice Address - Street 1:101 N PLAZA EAST BLVD STE 105
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2804
Practice Address - Country:US
Practice Address - Phone:812-402-5625
Practice Address - Fax:812-402-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty