Provider Demographics
NPI:1992878250
Name:GOES PHYSICIANS INC
Entity type:Organization
Organization Name:GOES PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-324-3937
Mailing Address - Street 1:2330 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1371
Mailing Address - Country:US
Mailing Address - Phone:937-324-3937
Mailing Address - Fax:937-324-8943
Practice Address - Street 1:2330 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1371
Practice Address - Country:US
Practice Address - Phone:937-324-3937
Practice Address - Fax:937-324-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2002988Medicaid
9289473Medicare ID - Type Unspecified
OH2002988Medicaid
OH9289475Medicare ID - Type Unspecified
OH9289471Medicare ID - Type Unspecified
OH9289474Medicare ID - Type Unspecified