| |
230-c East Main St., Gardner, KS 66030-1643 | |
(913) 856-8150 | |
(913) 856-8390 |
Full Name | |
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Type | Facility |
Speciality | Podiatrist - Foot & Ankle Surgery |
Location | 230-c East Main St., Gardner, Kansas |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1689967119 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 1200358KS (Kansas) | Secondary |
213ES0103X | Podiatrist - Foot & Ankle Surgery | 12-00358KS (Kansas) | Primary |
Provider Name | Jacob Goldstein |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1003896374 PECOS PAC ID: 8325011539 Enrollment ID: I20061016000490 |
Mailing Address | Practice Location Address |
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230-c East Main Street, Gardner, KS 66030-1643 Ph: (913) 856-8150 | 230-c East Main St., Gardner, KS 66030-1643 Ph: (913) 856-8150 |
Dr. Jacob B. Goldstein, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 230-c East Main St., Gardner, KS 66030 Phone: 913-856-8150 Fax: 913-856-8390 |