Provider Demographics
NPI:1841202389
Name:RICHARD MARTIN WALUS
Entity Type:Organization
Organization Name:RICHARD MARTIN WALUS
Other - Org Name:GOOD SAMARITAN MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:TORREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-742-2472
Mailing Address - Street 1:37555 SYCAMORE ST STE 7
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3939
Mailing Address - Country:US
Mailing Address - Phone:510-742-2472
Mailing Address - Fax:510-742-2462
Practice Address - Street 1:37555 SYCAMORE ST STE 7
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3939
Practice Address - Country:US
Practice Address - Phone:510-742-2472
Practice Address - Fax:510-742-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02439FMedicaid
CA4027470002Medicare NSC