Provider Demographics
NPI:1992899322
Name:WILLIAM M GOUMAS MD PC
Entity type:Organization
Organization Name:WILLIAM M GOUMAS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:OLORE
Authorized Official - Last Name:GOUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-225-0614
Mailing Address - Street 1:103 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401
Mailing Address - Country:US
Mailing Address - Phone:605-225-0614
Mailing Address - Fax:605-226-2692
Practice Address - Street 1:103 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-225-0614
Practice Address - Fax:605-226-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7301702Medicaid
SD40791Medicare ID - Type Unspecified
SD7301702Medicaid