Christopher David Goettl
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Bloomer, WI
NPI 1659638468 · NPPES record last updated Apr 18, 2012
Key facts
- NPI
- 1659638468
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1502 Main St
Bloomer, WI 54724-1639 - Phone
- (715) 568-2363
- NPI assigned
- Apr 18, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150605000782 | WI | Order and Referring Only - Dentist |
2961723705 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Diamond Family Dental SC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1502 Main St
Bloomer, WI 54724-1639
Mailing address
7312 100TH Ave
Chippewa Falls, WI 54729-5809
Phone (715) 495-3211
Other providers in Bloomer, WI
- Kathryn Ann Freagon
- Ilabeth Frei
- Full Circle Chiropractic and Wellness LLC
- Crystal Violet Getchell
- Richard E Gladitsch
- Dianne Marie Goettl
- Emily Suzanne Grace
- Lydia Gruben
- Lynn Hammond
- Marie Hansen
All providers in Bloomer, WI · Student in an Organized Health Care Education/Training Program in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.