| NPI | 1316358013 |
|---|---|
| Doing Business As | GOOD SAMARITAN MEDICINE RESIDENCY 12TH ST |
| Entity Type | Organization |
| Authorized Contact | DENNIS LARAWAY CFO 602-747-4000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: AZ 45424) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2022-01-31 |