Individual ProviderSean GoddardNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9025 Coldwater Rd Ste 100, Fort Wayne, IN 46825-2071(260) 459-9225PECOS EnrollmentBased on the most recent information from CMS, provider Sean Goddard is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1285117143Provider TypeIndividualFull NameGoddard, SeanCredentialNPGenderMaleSole ProprietorNoEnumeration Date9/7/2018Last Updated2/21/2024Contact InformationPractice LocationPractice Address9025 Coldwater Rd Ste 100, Fort Wayne, IN 46825-2071Phone(260) 459-9225Fax(260) 800-1512Mailing LocationMailing Address9025 Coldwater Rd Ste 100, Fort Wayne, IN 46825-2071Phone(260) 459-9225Fax(260) 800-1512Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28206231IndianaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense1133599Kentucky