Healthcare Provider Details

I. General information

NPI: 1689802365
Provider Name (Legal Business Name): GOOD SAMARITAN PAIN CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 ROUTE 228
MARS PA
16046-2325
US

IV. Provider business mailing address

943 ROUTE 228
MARS PA
16046-2325
US

V. Phone/Fax

Practice location:
  • Phone: 724-951-5583
  • Fax: 724-591-5563
Mailing address:
  • Phone: 724-951-5583
  • Fax: 724-591-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SOPHIE HANNA
Title or Position: OWNER
Credential: MD
Phone: 724-951-5583