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General NPI Number Information
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NPI Number | 1023087855
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN PHYSICAL THERAPY,INC.
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1901 MISSION 66 SUITE A
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City | VICKSBURG
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State | MS
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Zip | 39180-3711
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Country | US
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Telephone | 601-638-4076
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Fax | 601-638-4979
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Provider Business Mailing Address
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Address Line | PO BOX 822394
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City | VICKSBURG
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State | MS
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Zip | 39182-2394
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Country | US
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Telephone | 601-638-4076
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Fax | 601-638-4979
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. FERMIKA SMITH
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Credential |
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Telephone | 601-638-4076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State | MS
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