MR. EDWARD NMN GOLDSBOROUGH IV (NPI# 1053511394) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053511394 |
| Entity Type | Individual |
| Full Name | MR. EDWARD NMN GOLDSBOROUGH IV |
| Credential | IDC |
| Practice Address |
3001 A 6th St Great Lakes IL 60088 |
| Mailing Address |
8736 S 50th Ave Oak Lawn IL 60453-1340 |
| Practice Telephone | 8476884560 |
| Mailing Telephone | 8474544046 |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-07-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| Street Address |
3001 A 6TH ST |
| City | GREAT LAKES |
| State | IL |
| Zip Code | 60088 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164401246 | Gerald J. George | Pharmacist | 3001 A 6th St, Great Lakes, IL 60088 | 2006-01-17 |
| 1871721761 | Jason Ted Geary | Dentist | 3001 A 6th St, Naval Health Clinic, Great Lakes, IL 60088 | 2009-06-30 |
| 1134183270 | Christopher Lawrence Pulliam | Podiatrist | 3001 A 6th St, Naval Health Clinic, Great Lakes, IL 60088 | 2006-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858228 | Kathryn Ann Bird | Dentist | 3440 W Ohio St, Uss Osborne Branch Dental Clinic, Great Lakes, IL 60088 | 2019-12-18 |
| 1740775576 | Jonathan William Criter | Dentist | 3400 Ohio St, Great Lakes, IL 60088 | 2018-06-25 |
| 1134598733 | True Xiong | Dentist | Zachary & Elizabeth Fisher Medical & Dental Clinic, 2470 Sampson Street, Apo, AA 60088 | 2015-09-24 |
| 1447685771 | Lisa Carol Perrone | Dentist | Fhcc Lovell Bldg 237 Dental, Navsta Great Lakes, North Chicago, IL 60088 | 2013-09-05 |
| 1437438421 | David Lawrence Green | Dentist | 2410 Samson St., Bldg 237, Great Lakes, IL 60088 | 2011-08-09 |
| 1164730602 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois Street, Great Lakes, IL 60088 | 2010-09-17 |
| 1598073439 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois St, Bldg 1007, Great Lakes, IL 60088 | 2010-09-14 |
| 1164736302 | Clinton Lariscy | Military Health Care Provider | 3355 Illinois St, Recruit Training Command Great Lakes, Great Lakes, IL 60088 | 2010-07-29 |
| 1083943906 | James Doll | Dentist | 2608 Paul Jones St, Great Lakes, IL 60088 | 2009-12-24 |
| 1396996823 | Kelly Robert Lanning | Dentist | 3001 A 6th St Bhc 237, Naval Hospital Great Lakes- Dental Dept., Great Lakes, IL 60088 | 2008-10-02 |
| Find all providers in zip 60088 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215333299 | Jonathan Ramonbeebe | Military Health Care Provider | 3694 Minnesota Ave Apt D, Great Lakes, IL 60088-1714 | 2014-11-18 |
| 1164736302 | Clinton Lariscy | Military Health Care Provider | 3355 Illinois St, Recruit Training Command Great Lakes, Great Lakes, IL 60088 | 2010-07-29 |
| 1497917876 | Scott David Arnold | Military Health Care Provider | 320 Dewey Ave Ste A, Naval Special Warfare Preparatory School Bldg 322, Great Lakes, IL 60088-2911 | 2008-06-27 |
| 1184883688 | Michael Paul Coffman | Military Health Care Provider | 601 D Street, Great Lakes, IL 60088-2822 | 2008-06-09 |
| 1184809048 | Rodolfo Pineda Manansala | Military Health Care Provider | 601 D St Bldg 130-h, Great Lakes, IL 60088-2822 | 2008-01-09 |
| 1346454808 | Joseph Thomas Minich | Military Health Care Provider | 2410 Sampson St Bldg 237, Great Lakes, IL 60088-2942 | 2007-05-10 |
| 1679786057 | James R Butts | Military Health Care Provider | 329 Dewy Ave, Great Lakes, IL 60088 | 2007-05-08 |
| 1205891256 | Jose Alfredo Nicola | Military Health Care Provider | Naval Health Clininc Great Lakes, Branch Medical Clinic 1007 Uss Tranquility, Great Lakes, IL 60088 | 2006-04-20 |
| 1205804242 | Rodger M Howard | Military Health Care Provider | 3420 Illinois Street Bldg 1007, Great Lakes, IL 60088 | 2006-03-08 |
| 1144588039 | Luis Victor Fernandez | Military Health Care Provider | 2410 Sampson St, Great Lakes, IL 60088-2942 | 2012-04-27 |
| Find all providers in GREAT LAKES | ||||
| City | GREAT LAKES |
| Zip Code | 60088 |
Please comment or provide details below to improve the information on MR. EDWARD NMN GOLDSBOROUGH IV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.