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Elijah Chandler Goeglein

Student in an Organized Health Care Education/Training Program

Student, Health Care

19555 N 59th Ave, Glendale, AZ 85308-6813

PECOS Enrollment

This provider is enrolled in PECOS as ELIJAH GOEGLEIN.

Based on the most recent information from CMS, provider Elijah Chandler Goeglein is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1366260432
Provider Type
Individual
Full Name
Goeglein, Elijah Chandler
Gender
Male

Sole Proprietor
Yes
Enumeration Date
9/28/2024
Last Updated
9/28/2024

Contact Information

Practice Location

19555 N 59th Ave, Glendale, AZ 85308-6813

(623) 572-3200

Unlisted Fax

Mailing Location

19555 N 59th Ave, Glendale, AZ 85308-6813

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Elijah Chandler Goeglein

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Han, Moe-Myint

Wood, Andrew

Kargari, Samin

Jandu, Reetika

Heredia, Caitlyn

Muhajir, Mojir

Johnston, Madeline M

Kelbel, Mackenzie Ann

Musallam, Serene

Dellostritto, Daniel Justin