Basic Information
| Provider Information | |||||||||
| NPI: | 1235369208 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOEL DIAGNOSTIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1171 HART ST | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390464805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018599888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1171 HART ST | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390464805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018599888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2009 | ||||||||
| LastUpdateDate: | 07/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOEL | ||||||||
| AuthorizedOfficialFirstName: | PARVESH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6018599888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 15405 | MS | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.