NPI 1205802899

Goodwin Street Medical Supply LLC

Organisation Customized Equipment (DME) Prescott, AZ

Practice location

Address: 1202 Willow Creek Rd, Prescott, AZ 86301-1428
Phone: (928) 541-1825
Fax: (928) 541-1823

Authorised official

Name: Michelle Irene Herod
Title: Owner
Phone: (928) 541-1825

Registered specialties

Customized Equipment (DME) Primary

Suppliers Taxonomy 332BC3200X Licence 20002621 (AZ)

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Registry record

NPI: 1205802899
Entity type: Organization
NPI issued: 24 Feb 2006
Record last updated: 11 Jul 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.