Provider Demographics
NPI:1578512448
Name:GOOD SAMARITAN DEVICE CORP.
Entity Type:Organization
Organization Name:GOOD SAMARITAN DEVICE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ASUQWO
Authorized Official - Middle Name:F
Authorized Official - Last Name:EKENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-980-4733
Mailing Address - Street 1:4611 S MAIN ST
Mailing Address - Street 2:STE. 8B
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4731
Mailing Address - Country:US
Mailing Address - Phone:281-980-4733
Mailing Address - Fax:281-313-0590
Practice Address - Street 1:4611 S MAIN ST
Practice Address - Street 2:STE. 8B
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4731
Practice Address - Country:US
Practice Address - Phone:281-980-4733
Practice Address - Fax:281-313-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0084201332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4929380001Medicare ID - Type Unspecified