Provider Demographics
NPI:1851651988
Name:WESTSIDE SAMARITANS CLINIC INC
Entity Type:Organization
Organization Name:WESTSIDE SAMARITANS CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:KLOSSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-333-7700
Mailing Address - Street 1:10000 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-5544
Mailing Address - Country:US
Mailing Address - Phone:352-333-7700
Mailing Address - Fax:352-333-9009
Practice Address - Street 1:10000 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5544
Practice Address - Country:US
Practice Address - Phone:352-333-7700
Practice Address - Fax:352-333-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QF0400X
FLN12000000613-VHCPP261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)