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General NPI Number Information
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NPI Number | 1235841545
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN VENTURES LLC
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 3607 S MAIN ST STE 104
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City | STAFFORD
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State | TX
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Zip | 77477-5406
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Country | US
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Telephone | 713-866-4021
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Fax | 713-866-6560
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Provider Business Mailing Address
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Address Line | 3607 S MAIN ST STE 104
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City | STAFFORD
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State | TX
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Zip | 77477-5406
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Country | US
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Telephone | 713-866-4021
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Fax | 713-866-6560
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Authorized Official
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Title or Position | CEO/PHARMACIST IN CHARGE
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Name | MR. ABIEL HAILEAB TSEGAI
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Credential | PHARMACIST
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Telephone | 713-866-4021
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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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