# GOOD SAMARITAN CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144608746
- **Authorized official:** EVAN BREEDLOVE (ADMINISTRATOR)
- **Authorized official phone:** (479) 783-0233

## Contact information

- **Practice address:** 615 NORTH B STREET, FORT SMITH, AR 72901
- **Practice address phone:** (479) 783-0233
- **Mailing address:** 615 NORTH B STREET, FORT SMITH, AR 72901
- **Mailing address phone:** (479) 783-0233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2015
- **Last updated:** 05/14/2015