GODDARD MEDICAL GROUP, LLC (NPI# 1396377412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396377412 |
| Entity Type | Organization |
| Organization Name | GODDARD MEDICAL GROUP, LLC |
| Practice Address |
1465 Kelly Johnson Blvd Ste 110 Colorado Springs CO 80920-3945 |
| Mailing Address |
2250 E Germann Rd Ste 8 Chandler AZ 85286-1575 |
| Practice Telephone | 7194456077 |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2020-02-06 |
| Authorized Official Name | MINOO RAHIMI (CFO) |
| Authorized Official Telephone | 4809267800 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | Chiropractic Providers | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | GODDARD MEDICAL GROUP, LLC | 1465 Kelly Johnson Blvd Ste 110, Colorado Springs, CO 80920 |
| Street Address |
1465 KELLY JOHNSON BLVD STE 110 |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80920-3945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023640141 | Kelly Johnson Medical Group, LLC | Chiropractor | 1465 Kelly Johnson Blvd Ste 110, Colorado Springs, CO 80920-3945 | 2020-02-06 |
| 1821620956 | Academy Medical Group, LLC | Physical Therapist | 1465 Kelly Johnson Blvd Ste 110, Colorado Springs, CO 80920-3945 | 2020-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407463409 | Cynthia Cruz | Marriage & Family Therapist | 7710 N. Union, Ste 100b and 100c, Colorado Springs, CO 80920 | 2020-09-24 |
| 1851905178 | Emergency Medical Specialists, PC | Emergency Medicine | Woodmen Fsed - Md, 3790 E. Woodmen Road, Colorado Springs, CO 80920 | 2020-09-03 |
| 1114531431 | Emergency Medical Specialists, PC | Emergency Medicine | Memorial Hospital North - Md, 4050 Briargate Pkway, Colorado Springs, CO 80920 | 2020-09-03 |
| 1205440583 | Emergency Medical Specialists, PC | Emergency Medicine | Memorial Hospital North - App, 4050 Briargate Pkway, Colorado Springs, CO 80920 | 2020-09-03 |
| 1700490455 | Poudre Valley Medical Group, LLC | Radiology | 4080 Briargate Parkway, Colorado Springs, CO 80920 | 2020-09-01 |
| 1962015792 | Emergency Medical Specialists, PC | Emergency Medicine | Woodmen Fsed - App, 3790 E. Woodmen Road, Colorado Springs, CO 80920 | 2020-08-31 |
| 1194296491 | Kramer Dentistry Inc | Clinic/Center | 9290 Highland Ridge Heights Suite # 120, Colorado Springs, CO 80920 | 2018-12-12 |
| 1134602279 | Juliana Plucinik | Assistant Behavior Analyst | 7011 Campus Drive Suite 205, Colorado Springs, CO 80920 | 2018-09-14 |
| 1811473861 | Vsb Colorado Providers Pllc | Dentist | 1750 Telstar Drive, Suite 200, Colorado Springs, CO 80920 | 2018-07-12 |
| 1336637438 | Children's Hospital Colorado | General Acute Care Hospital | 4090 Briargate Parkway, Colorado Springs, CO 80920 | 2018-04-25 |
| Find all providers in zip 80920 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316569387 | Poudre Valley Medical Group, LLC | General Practice | 4050 Briargate Pkwy Fl 4, Colorado Springs, CO 80920-7815 | 2020-05-13 |
| 1215584321 | Belleview Spince and Wellnces Cos LLC | General Practice | 1257 Lake Plaza Dr Ste 105, Colorado Springs, CO 80906-7300 | 2019-08-22 |
| 1215499967 | Stanley Leon Rapaport | General Practice | 3920 E San Miguel St Apt 129, Colorado Springs, CO 80909-3416 | 2019-04-02 |
| 1972009637 | Optimal Therapy Billing | General Practice | 6547 N Academy Blvd Ste 1131, Colorado Springs, CO 80918-8342 | 2018-04-02 |
| 1710487939 | Imed Integration LLC | General Practice | 6190 Lehman Dr Ste 100b, Colorado Springs, CO 80918-3445 | 2018-02-14 |
| 1982102406 | Medevals of Colorado, Inc. | General Practice | 1233 Lake Plaza Dr Ste B, Colorado Springs, CO 80906-3567 | 2018-01-30 |
| 1699164152 | Peak Performance Pt/md,llc | General Practice | 540 Mesa Vista Ct, Colorado Springs, CO 80904-2541 | 2015-01-21 |
| 1548668429 | Paul Baker Md PC | General Practice | 9703 Pinedale Dr, Colorado Springs, CO 80920-2443 | 2014-12-09 |
| 1235575457 | Barbara Meduna | General Practice | 14530 Silverton Rd, Colorado Springs, CO 80921-2944 | 2013-05-14 |
| 1184972598 | Courtney Crance | General Practice | 1715 N Weber St Ste 330, Colorado Springs, CO 80907-7554 | 2012-08-16 |
| Find all providers in COLORADO SPRINGS | ||||
| City | COLORADO SPRINGS |
| Zip Code | 80920 |
Please comment or provide details below to improve the information on GODDARD MEDICAL GROUP, LLC.
| 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.