# GODDARD MEDICAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366033359
- **Authorized official:** DR. MARIA SHEELENE GODDARD MD (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (913) 735-9044

## Contact information

- **Practice address:** 11936 W 119TH ST \# 158, OVERLAND PARK, KS 66213-2216
- **Practice address phone:** (913) 735-9044
- **Mailing address:** 11936 W 119TH ST \# 158, OVERLAND PARK, KS 66213-2216
- **Mailing address phone:** (913) 735-9044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/01/2021
- **Last updated:** 02/25/2021