Provider Demographics
NPI:1356841779
Name:GOOD SAMARITAN CLINIC OF WESTERN COLORADO
Entity Type:Organization
Organization Name:GOOD SAMARITAN CLINIC OF WESTERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTUVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-290-1552
Mailing Address - Street 1:402 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2534
Mailing Address - Country:US
Mailing Address - Phone:970-712-6518
Mailing Address - Fax:
Practice Address - Street 1:402 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2534
Practice Address - Country:US
Practice Address - Phone:970-712-6518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FC0340OtherFTCA FREE CLINIC