Provider Demographics
NPI:1013127364
Name:GOOD SAMARITAN CLINIC
Entity Type:Organization
Organization Name:GOOD SAMARITAN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-439-9616
Mailing Address - Street 1:305 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3782
Mailing Address - Country:US
Mailing Address - Phone:828-439-9945
Mailing Address - Fax:828-439-9917
Practice Address - Street 1:305 W UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3782
Practice Address - Country:US
Practice Address - Phone:828-439-9945
Practice Address - Fax:828-439-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center