=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871149427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD SAMARITAN TRANSIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2019
-----------------------------------------------------
Last Update Date | 08/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3215 STONEWATER GLEN LN
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27519-0962
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-818-8425
-----------------------------------------------------
Fax | 919-234-1025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1265
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-1265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-818-8425
-----------------------------------------------------
Fax | 919-234-1025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | MR. RAOUF FOUAD SRAFEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-818-8425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------