Healthcare Provider Details

I. General information

NPI: 1972761997
Provider Name (Legal Business Name): GOOD SAMARITAN URGENT CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 OLIVE DR
BAKERSFIELD CA
93308-4137
US

IV. Provider business mailing address

6001 TRUXTUN AVE SUITE 160
BAKERSFIELD CA
93309-0679
US

V. Phone/Fax

Practice location:
  • Phone: 661-215-7551
  • Fax:
Mailing address:
  • Phone: 661-323-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberFNP23615
License Number StateCA

VIII. Authorized Official

Name: LUCINDA LEE FERRIS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 661-215-7669