=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851941876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD SAMARITAN MED SUPPLY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2019
-----------------------------------------------------
Last Update Date | 05/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37555 SYCAMORE ST STE 7
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94560-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-742-2472
-----------------------------------------------------
Fax | 510-742-2462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37555 SYCAMORE ST STE 7
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94560-3939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-742-2472
-----------------------------------------------------
Fax | 510-742-2462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MISS HOLLY JOANNE TORREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-783-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------