Provider Demographics
NPI:1770536401
Name:THE GOOD SAMARITAN-A FAMILY HEALTH CARE FACILITY, INC
Entity type:Organization
Organization Name:THE GOOD SAMARITAN-A FAMILY HEALTH CARE FACILITY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-688-5020
Mailing Address - Street 1:PO BOX 676
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0676
Mailing Address - Country:US
Mailing Address - Phone:316-685-3698
Mailing Address - Fax:
Practice Address - Street 1:3701 E 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2080
Practice Address - Country:US
Practice Address - Phone:316-688-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016379OtherBCBS
CS0608OtherRAILROAD MEDICARE
KS016379OtherBCBS