Provider Demographics
NPI:1639471949
Name:GOOD SAMARITAN SERVICES LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:CASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-650-5438
Mailing Address - Street 1:320 REINDEER MOSS CT
Mailing Address - Street 2:STE. 201
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-8725
Mailing Address - Country:US
Mailing Address - Phone:843-650-5438
Mailing Address - Fax:843-650-5433
Practice Address - Street 1:320 REINDEER MOSS CT
Practice Address - Street 2:STE. 201
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-8725
Practice Address - Country:US
Practice Address - Phone:843-650-5438
Practice Address - Fax:843-650-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPSC # 8172343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)