Allen Christopher Gooch, M.D.
Individual provider
Active NPI
Surgery Physician · Fulton, KY
NPI 1790736445 · NPPES record last updated Jul 10, 2015
Key facts
- NPI
- 1790736445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 10000 (TN)
- Practice address
- 2002 Holiday LN
Ste 100
Fulton, KY 42041-8468
- Phone
- (270) 472-8150
- Fax
- (270) 472-8155
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20090115000410 |
TN |
Practitioner - General Surgery |
6608942131 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|
| TP902 | KY | MD | Pediatric Radiology Physician |
| 1000 | TN | MD | Certified Respiratory Therapist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Surgery Physician |
208600000X |
10000 |
TN |
Yes |
Addresses
Primary practice location
2002 Holiday LN
Ste 100
Fulton, KY 42041-8468
Mailing address
2002 Holiday LN
Ste 100
Fulton, KY 42041-8468
Phone (270) 472-8150
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 3194557 | Medicaid | TN | |