Provider Demographics
NPI:1689802365
Name:GOOD SAMARITAN PAIN CLINIC, PC
Entity Type:Organization
Organization Name:GOOD SAMARITAN PAIN CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-951-5583
Mailing Address - Street 1:7011 CRIDER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-2383
Mailing Address - Country:US
Mailing Address - Phone:724-951-5583
Mailing Address - Fax:
Practice Address - Street 1:7011 CRIDER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2383
Practice Address - Country:US
Practice Address - Phone:724-951-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty