| Goodside Health Medical, Pllc | |
|
9910 Indian School Rd Ne Ste 204 Albuquerque NM 87112-2971 | |
| (512) 884-5190 | |
| Not Available |
| Full Name | Goodside Health Medical, Pllc |
|---|---|
| Speciality | Pediatrics |
| Location | 9910 Indian School Rd Ne Ste 204, Albuquerque, New Mexico |
| Authorized Official Name and Position | Brian White (CEO) |
| Authorized Official Contact | 8172440101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goodside Health Medical, Pllc 1701 River Run Ste 302 Fort Worth TX 76107-6547 Ph: () - | Goodside Health Medical, Pllc 9910 Indian School Rd Ne Ste 204 Albuquerque NM 87112-2971 Ph: (512) 884-5190 |
| NPI Number | 1033972716 |
|---|---|
| Provider Enumeration Date | 02/05/2024 |
| Last Update Date | 06/13/2024 |
| Medicare PECOS PAC ID | 1557745478 |
|---|---|
| Medicare Enrollment ID | O20240702002144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033972716 | NPI | - | NPPES |
| Provider Name | Gerardo Reyes |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194767954 PECOS PAC ID: 1153429576 Enrollment ID: I20240702002368 |
| Provider Name | Elizabeth Rosenberg |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891215612 PECOS PAC ID: 2769886563 Enrollment ID: I20241011000798 |
| Provider Name | Jesse Zaitchik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194052779 PECOS PAC ID: 6406986959 Enrollment ID: I20241011001010 |
| Provider Name | Domingo Palomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275025983 PECOS PAC ID: 2062849235 Enrollment ID: I20241105004089 |
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