GOOD SAMARITAN FAMILY WALK-IN CLINIC, LLC (NPI# 1588964811) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588964811 |
| Entity Type | Organization |
| Organization Name | GOOD SAMARITAN FAMILY WALK-IN CLINIC, LLC |
| Practice Address |
1869 Highway 45 Byp Suite 4 Jackson TN 38305-2464 |
| Practice Telephone | 7312152277 |
| Practice Fax Number | 7312152318 |
| Mailing Telephone | 7312152277 |
| Mailing Fax Number | 7312152318 |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2010-11-03 |
| Authorized Official Name | MARIA TERESA ORTEGA (FNP/OWNER) |
| Authorized Official Telephone | 7312152277 |
| Authorized Official Credential | FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
10533 | TN | Ambulatory Health Care Facilities |
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
10533 | TN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1519182 | 05 |
| Street Address |
1869 HIGHWAY 45 BYP SUITE 4 |
| City | JACKSON |
| State | TN |
| Zip Code | 38305-2464 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871752105 | Raleigh Professional Associates | Clinic/Center | 1869 Highway 45 Byp, Suite 5, Jackson, TN 38305-2464 | 2008-06-02 |
| 1225462088 | Traci Robinson | Licensed Practical Nurse | 1869 Highway 45 Byp, Suite 5, Jackson, TN 38305-2464 | 2013-08-29 |
| 1265866024 | Gloretta Dianna Turner | Licensed Practical Nurse | 1869 Highway 45 Byp, Jackson, TN 38305-2464 | 2013-08-29 |
| 1689008401 | Carolyn Ann Thomas | Licensed Practical Nurse | 1869 Highway 45 Byp, Suite 5, Jackson, TN 38305-2464 | 2013-08-28 |
| 1639515646 | Vcphcs Xix, LLC | Clinic/Center | 1869 Highway 45 Byp, Suite 5, Jackson, TN 38305-2464 | 2013-05-16 |
| 1447496435 | Harnisch Wellness Clinic Inc | Clinic/Center | 1869 Highway 45 Byp, Suite 2b, Jackson, TN 38305-2464 | 2008-12-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427656818 | Kimaya Jelks | Specialist | 1869 45 Hwy Bypass, Suite 2b, Jackson, TN 38305 | 2020-10-16 |
| 1821600578 | Maame Obeng | Pharmacist | 3144 North Highland Avenue, Jackson, TN 38305 | 2020-08-22 |
| 1700361904 | James Cowie | Psychologist | 156c West University Pkwy, Jackson, TN 38305 | 2018-10-03 |
| 1700372109 | Chad Zawacki | Physician Assistant | 147 North Star Drive, Jackson, TN 38305 | 2018-07-09 |
| 1104323070 | Golden Years Adult Day Care | Clinic/Center | 155 Carriage Dr Suite A, Jackson, TN 38305 | 2018-04-09 |
| 1245754563 | Tanika Annette Gillard | Massage Therapist | 4 Hampton Ln, Jackson, TN 38305 | 2017-07-28 |
| 1316488117 | Lakisha T Ingram | Counselor | 168 Greencastle Dr, Jackson, TN 38305 | 2017-03-13 |
| 1619421567 | D & L Wellness Inc | Community/Behavioral Health | 154 Carriage House Dr., Jackson, TN 38305 | 2016-08-09 |
| 1649637638 | Advance Choice Home Care LLC | In Home Supportive Care | 1028 Ashport Rd., Jackson, TN 38305 | 2016-01-21 |
| 1942666151 | Neurohealth Solutions Inc. | Clinic/Center | 174 Murray Guard Dr. Suite E, Jackson, TN 38305 | 2016-01-05 |
| Find all providers in zip 38305 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710545488 | Primary and Behavioral Healthcare Services, Pa | Clinic/Center | 717 E. Fortification St., Jackson, MS 39202-2402 | 2019-05-29 |
| 1366928087 | Primary Care - South Limited | Clinic/Center | 1385 South Highland Ave, Suite B-1, Jackson, TN 38301 | 2018-07-16 |
| 1114427507 | Advance Care, LLC | Clinic/Center | 14 Northtown Dr Ste 105, Jackson, MS 39211-3018 | 2018-02-13 |
| 1467841742 | Dc Medical Services Inc | Clinic/Center | 7 Stonebridge Blvd Ste C, Jackson, TN 38305-2049 | 2015-01-09 |
| 1558779728 | Rural Health Group, Inc. | Clinic/Center | 9742 Nc Highway 305, Jackson, NC 27845-9799 | 2014-07-31 |
| 1043573199 | Fondren Medical Clinic | Clinic/Center | 4436 N State St, Suite A-1, Jackson, MS 39206-5334 | 2012-06-22 |
| 1043503832 | Mid Jackson Family Health Clinic | Clinic/Center | 514c Woodrow Wilson Dr, Jackson, MS 39216 | 2011-05-26 |
| 1053646190 | More Convenient Care Center LLC | Clinic/Center | 4612 Medgar Evers Blvd, Suite 10, Jackson, MS 39213-5205 | 2009-10-07 |
| 1518121326 | University Nursing Associates Pllc | Clinic/Center | 136 W Ash St, Jackson, MS 39202-2217 | 2008-07-11 |
| 1114194347 | Community Action Committee of Pike County | Clinic/Center | 14590 St Rt 93, Family Health Center Jackson, Jackson, OH 45640 | 2008-05-16 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on GOOD SAMARITAN FAMILY WALK-IN CLINIC, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.