Goodwin Street Medical Supply LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

20002621 Issued in AZ

Legal business name

GOODWIN STREET MEDICAL SUPPLY LLC

Practice address

1202 Willow Creek Rd
Prescott, AZ 86301-1428

Phone

(928) 541-1825

Fax

(928) 541-1823

NPI assigned

Feb 24, 2006

Organization subpart

No

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

Authorized official

Name

Michelle Irene Herod

Title

Owner

Phone

(928) 541-1825

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783728000000",
    "number": "1205802899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011428",
            "telephone_number": "928-541-1825",
            "fax_number": "928-541-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011428",
            "telephone_number": "928-541-1825",
            "fax_number": "928-541-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWIN STREET MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2026-07-11",
        "certification_date": "2026-07-11",
        "status": "A",
        "authorized_official_last_name": "HEROD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-541-1825"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "AZ",
            "license": "20002621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Customized Equipment (DME) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.