Organization
GOODSIDE HEALTH MEDICAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN WHITE (CEO)
(817) 244-0101
Entity
Organization
Contact information
Practice address
9910 INDIAN SCHOOL RD NE STE 204, ALBUQUERQUE, NM 87112-2971
(512) 884-5190
Mailing address
1701 RIVER RUN STE 302, FORT WORTH, TX 76107-6547
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/05/2024
Last updated
06/13/2024
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