BRADLEY TAIT GOETTL FNP NPI 1740694454

NPI Information

NPI: 1740694454
Provider Name: BRADLEY TAIT GOETTL, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
4502 MEDICAL DR
SAN ANTONIO, TX
ZIP 78229
Phone: (210) 358-2078
Get Directions

Bradley Tait Goettl, FNP is a family nurse practitioner in San Antonio, TX with 10 years of experience. Bradley Tait Goettl, FNP NPI is 1740694454. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4502 MEDICAL DR
SAN ANTONIO, TX
ZIP 78229-402
Phone: (210) 358-2078
Fax: (210) 358-1972

The NPI 1740694454 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/20/2014 and was last updated on 9/27/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	146L00000X	Emergency Medical Technician, Paramedic		709205	TEXAS	No
2	163WE0003X	Registered Nurse	Emergency	766200	TEXAS	No
3	363LF0000X	Nurse Practitioner	Family	6653-33	WISCONSIN	No
4	363LF0000X	Nurse Practitioner	Family	AP125858	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	339105407	MEDICAID	TEXAS
2	339105408	OTHER	TEXAS	CSHCN
3	365497YK00	MEDICARE UPIN	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »