Provider Demographics
NPI:1437723632
Name:GOOD SAMARITAN TRANSITIONAL CARE & WOUND SPECIALIST
Entity Type:Organization
Organization Name:GOOD SAMARITAN TRANSITIONAL CARE & WOUND SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-500-1993
Mailing Address - Street 1:1500 E TROPICANA AVE STE 161
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6516
Mailing Address - Country:US
Mailing Address - Phone:702-334-2166
Mailing Address - Fax:702-462-2326
Practice Address - Street 1:1500 E TROPICANA AVE STE 161
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6516
Practice Address - Country:US
Practice Address - Phone:702-334-2166
Practice Address - Fax:702-462-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty