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Organization
GOOD SAMARITAN PHYSICAL THERAPY,INC.
Active
Organization
GOOD SAMARITAN PHYSICAL THERAPY,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FERMIKA SMITH (BILLING MANAGER)
(601) 638-4076
Entity
Organization
Contact information
Practice address
1901 MISSION 66, SUITE A, VICKSBURG, MS 39180-3711
(601) 638-4076
(601) 638-4979
Mailing address
PO BOX 822394, VICKSBURG, MS 39182-2394
(601) 638-4076
(601) 638-4979
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
MS
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050976
BLUE CROSS NUMBER
MS
05
—
09015117
—
MS
05
—
1465739
—
LA
01
—
174112500
OWCP
MS
01
—
4253810001
DME
MS
01
—
5429586
AETNA PROVIDER NUMBER
MS
01
—
6430026
UNITED HEALTH CARE NUMBER
MS
Enumeration date
03/15/2006
Last updated
07/21/2022
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