NPIMap

Organization Active NPI

P C Goodwin Medical LLC

  • Internal Medicine Physician
  • Evergreen Park, IL
National Provider Identifier
1013110444
Registry record updated Sep 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036076189 Issued in IL
Legal business name
P C GOODWIN MEDICAL LLC
Practice address
9401 S Pulaski Rd
Suite 101
Evergreen Park, IL 60805-1924
Phone
(708) 424-2475
Fax
(708) 424-2494
NPI assigned
Jun 5, 2007
Last updated
Sep 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Pamela Denise Goodwin-Cole, M.D.
Title
President & Ceo
Phone
(708) 424-2475

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036076189 IL Primary

Addresses

Primary practice location

9401 S Pulaski Rd
Suite 101
Evergreen Park, IL 60805-1924

Mailing address

18507 Indie CT
Hazel Crest, IL 60429-2469
Phone (708) 204-0786

National Provider Directory

National Provider Directory

Locations

9401 S Pulaski Rd
Ste 101
Evergreen Pk, IL 60805
Phone (708) 422-3737

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221609600000",
    "number": "1013110444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18507 INDIE CT",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292469",
            "telephone_number": "708-204-0786",
            "fax_number": "708-647-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 S PULASKI RD",
            "address_2": "SUITE 101",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608051924",
            "telephone_number": "708-424-2475",
            "fax_number": "708-424-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P C GOODWIN MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2008-09-17",
        "status": "A",
        "authorized_official_last_name": "GOODWIN-COLE",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "708-424-2475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036076189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.