| Charles B. Goss, D.o., P.c. | |
|
28100 Grand River Ave Suite 102 Farmington Hills MI 48336-5967 | |
| (248) 471-5700 | |
| (248) 851-5515 |
| Full Name | Charles B. Goss, D.o., P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 28100 Grand River Ave, Farmington Hills, Michigan |
| Authorized Official Name and Position | Charles B. Goss (PRESIDENT) |
| Authorized Official Contact | 2484715700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles B. Goss, D.o., P.c. 28100 Grand River Ave Suite 102 Farmington Hills MI 48336-5967 Ph: (248) 471-5700 | Charles B. Goss, D.o., P.c. 28100 Grand River Ave Suite 102 Farmington Hills MI 48336-5967 Ph: (248) 471-5700 |
| NPI Number | 1306903109 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 01/25/2008 |
| Medicare PECOS PAC ID | 3072693662 |
|---|---|
| Medicare Enrollment ID | O20080111000280 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306903109 | NPI | - | NPPES |
| 1091313 11 00 | Medicaid | MI | |
| 260F338480 | Other | MI | BLUE CROSS & BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Charles B Goss |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952468779 PECOS PAC ID: 7810077401 Enrollment ID: I20080111000270 |
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