Organization
GOODWIN STREET MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE IRENE HEROD (OWNER)
(928) 541-1825
Entity
Organization
Contact information
Practice address
406 W GOODWIN ST, STE 1, PRESCOTT, AZ 86303-3737
(928) 541-1825
(928) 541-1823
Mailing address
406 W GOODWIN ST, STE 1, PRESCOTT, AZ 86303-3737
(928) 541-1825
(928) 541-1823
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
20002621
AZ
Other
Enumeration date
02/24/2006
Last updated
05/21/2015
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