Provider Demographics
NPI:1033647128
Name:GOOD SAMARITAN PHYSICIANS ASSOCIATION, INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN PHYSICIANS ASSOCIATION, INC.
Other - Org Name:ARIZONA STATE PHYSICIANS ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-265-2524
Mailing Address - Street 1:3030 N CENTRAL AVE STE 1405
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2720
Mailing Address - Country:US
Mailing Address - Phone:602-265-2524
Mailing Address - Fax:602-265-3289
Practice Address - Street 1:3030 N CENTRAL AVE STE 1405
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2720
Practice Address - Country:US
Practice Address - Phone:602-265-2524
Practice Address - Fax:602-265-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization