Healthcare Provider Details

I. General information

NPI: 1639100951
Provider Name (Legal Business Name): GOOD SAMARITAN OUTREACH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 31ST ST
KEARNEY NE
68847-2926
US

IV. Provider business mailing address

10 E 31ST ST
KEARNEY NE
68847-2926
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-7100
  • Fax:
Mailing address:
  • Phone: 308-865-7900
  • Fax: 308-865-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL H SCHNIEDERS
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 308-865-7900