Goodside Health Medical, Pllc | |
1701 River Run Ste 302 Fort Worth TX 76107-6547 | |
(281) 203-5006 | |
Not Available |
Full Name | Goodside Health Medical, Pllc |
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Speciality | Pediatrics |
Location | 1701 River Run Ste 302, Fort Worth, Texas |
Authorized Official Name and Position | Gerardo Reyes (OWNER) |
Authorized Official Contact | 6304871556 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Goodside Health Medical, Pllc 1701 River Run Ste 302 Fort Worth TX 76107-6547 Ph: (281) 203-5006 | Goodside Health Medical, Pllc 1701 River Run Ste 302 Fort Worth TX 76107-6547 Ph: (281) 203-5006 |
NPI Number | 1548999451 |
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Provider Enumeration Date | 06/07/2022 |
Last Update Date | 04/28/2023 |
Medicare PECOS PAC ID | 1557745478 |
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Medicare Enrollment ID | O20220826000394 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548999451 | NPI | - | NPPES |
Provider Name | Bethany Mcclean |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639148190 PECOS PAC ID: 5991738411 Enrollment ID: I20050915000346 |
Provider Name | Jesse R Zaitchik |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1194052779 PECOS PAC ID: 6406986959 Enrollment ID: I20100610000503 |
Provider Name | Sabrina Didarali |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1508118282 PECOS PAC ID: 1052564598 Enrollment ID: I20130110000599 |
Provider Name | Donna Ignacio Vasquez |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1154333169 PECOS PAC ID: 5496759136 Enrollment ID: I20140617002051 |
Provider Name | Monica Danielle Lennox |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467822114 PECOS PAC ID: 2264733559 Enrollment ID: I20151210000146 |
Provider Name | Laura R Driggers |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952757825 PECOS PAC ID: 9537459128 Enrollment ID: I20160610000638 |
Provider Name | Bear B Causseaux |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1770034548 PECOS PAC ID: 5799068052 Enrollment ID: I20170210001177 |
Provider Name | Gillian Elisabeth Palmer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528583556 PECOS PAC ID: 3274807516 Enrollment ID: I20170925002752 |
Provider Name | Sujan Gogu |
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Provider Type | Practitioner - Sports Medicine |
Provider Identifiers | NPI Number: 1407268162 PECOS PAC ID: 8729357116 Enrollment ID: I20180912001243 |
Provider Name | Magaly Orozco |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922576123 PECOS PAC ID: 5597001586 Enrollment ID: I20190111002368 |
Provider Name | Leigh A Dixon |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1558342360 PECOS PAC ID: 5496705576 Enrollment ID: I20191112000990 |
Provider Name | Domingo Palomo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1275025983 PECOS PAC ID: 2062849235 Enrollment ID: I20200227002414 |
Provider Name | Gerardo Reyes |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1194767954 PECOS PAC ID: 1153429576 Enrollment ID: I20200422000965 |
Provider Name | Christa R Rosenberg |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1619238912 PECOS PAC ID: 1759697626 Enrollment ID: I20211108001306 |
Provider Name | Julia Lowe |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992050314 PECOS PAC ID: 9638326218 Enrollment ID: I20211117000440 |
Provider Name | Nicole Ivett Blanco |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427758382 PECOS PAC ID: 1355707563 Enrollment ID: I20230512002590 |
Provider Name | Lindsay Agolia |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1831351063 PECOS PAC ID: 6406081421 Enrollment ID: I20230529000090 |
Provider Name | Alison Glee Reagan |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1568088581 PECOS PAC ID: 9335506468 Enrollment ID: I20230606001033 |
Provider Name | Tatianna Natalia Mai |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972183895 PECOS PAC ID: 3971961806 Enrollment ID: I20230623002831 |
Provider Name | Elizabeth Rosenberg |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1891215612 PECOS PAC ID: 2769886563 Enrollment ID: I20230817002343 |
Provider Name | Lauren Viergever |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598432544 PECOS PAC ID: 3678921939 Enrollment ID: I20231127002190 |
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